title: Are transition zone biopsies still necessary to improve prostate cancer detection? Results from the tyrol screening project.
abstract: OBJECTIVE
  The present retrospective study was designed to investigate the value of transition zone (TZ) biopsies for prostate cancer (PC) detection rate in a combined contrast enhanced color Doppler targeted (CECD) and gray-scale systematic biopsy (SB) approach.
  
  
  METHODS
  PSA screening participants totalling 1475 with tPSA of >1.25 ng/ml (fPSA< or =18%) were assessed. Ten SB and additionally 5 or fewer CECD were performed. The impact of TZ biopsies on the PC detection rate and the biological significance of the detected TZ-cancers were analyzed.
  
  
  RESULTS
  Out of 1475 biopsied patients, 395 (26.8%) were identified as PC patients; 5925 biopsy cores from these patients were analyzed. In 86 patients (21.8% of PC), we found 102 PC- positive cores in the TZ, and only in 9 of them solitary TZ-cancers without any other PC-location (2.3% of PC or 0.6% of all investigated patients). Pathologic findings after retropubic prostatectomy (RPE) revealed multifocal adenocarcinoma including involved peripheral zone (PZ) in eight of these nine patients, and solitary TZ-cancer in one patient. There was no positive correlation between prostate volume and TZ-detection rate and no patient with solitary TZ-PC after rebiopsy.
  
  
  CONCLUSIONS
  Biopsy revealed 9 solitary TZ cancers (1.8%) and RPE revealed only one of them to be truly TZ-confined cancer (0.6%). Furthermore PC-detection did not improve, even in patients with rebiopsy, and there was no correlation between detection of TZ-cancers and prostate volume. A combined use of CECD and SB to investigate participants of a PSA-screening program suggests that TZ-biopsies do not improve PC detection rate and are therefore unnecessary.
authors.affiliation: Department of Urology, Innsbruck Medical University, Austria. alexandre.pelzer@uibk.ac.at
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Pelzer
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bektic
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Berger
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Halpern
authors.forename: Florian
authors.initials: F
authors.lastname: Koppelstätter
authors.forename: Andrea
authors.initials: A
authors.lastname: Klauser
authors.forename: Peter
authors.initials: P
authors.lastname: Rehder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Frauscher
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle / Q000379:methods*; D003287:Contrast Media; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D017430:Prostate-Specific Antigen