Are transition zone biopsies still necessary to improve prostate cancer detection? Results from the tyrol screening project.
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.
Pelzer
Alexandre E
AE
Department of Urology, Innsbruck Medical University, Austria. alexandre.pelzer@uibk.ac.at
Bektic
Jasmin
J
Berger
Andreas P
AP
Halpern
Ethan J
EJ
Koppelstätter
Florian
F
Klauser
Andrea
A
Rehder
Peter
P
Horninger
Wolfgang
W
Bartsch
Georg
G
Frauscher
Ferdinand
F
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
D014408:Biomarkers, Tumor; D003287:Contrast Media; D017430:Prostate-Specific Antigen