title: Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection.
abstract: OBJECTIVE
  Previous studies have indicated that 6-core transrectal prostate biopsy misses a considerable number of cancers. We performed an extensive biopsy protocol of 12-core sampling using both transperineal and transrectal approaches to determine the impact on the cancer detection rate.
  
  
  METHODS
  We prospectively evaluated 402 men who underwent 6-core transperineal and 6-core transrectal biopsies simultaneously due to abnormal digital rectal examination (DRE) and/or elevated prostate-specific antigen (PSA) levels of 4.0 ng/mL or greater. Using the transperineal approach we obtained four cores from the bilateral peripheral zone targeting the lateral and parasagittal areas and two cores from the bilateral transition zone. The following transrectal biopsy was performed traditionally. We compared cancer detection rate between the extended 12-core procedure and conventional 6-core transperineal and transrectal groups in terms of total PSA and DRE findings.
  
  
  RESULTS
  Using the extensive combined method, prostate cancer was detected in 195 cases (48.5%) and the detection rate significantly increased 7.2% and 8.5% compared to the transperineal and transrectal groups, respectively. According to PSA levels and DRE findings, the cancer detection rate by the combined method was significantly improved in patients with PSA levels of 4-10 ng/mL and negative DRE: 10.3% and 11.6% compared to the transperineal and transrectal groups, respectively.
  
  
  CONCLUSIONS
  The extensive 12-core method significantly improved the overall cancer detection rate and was especially efficient for men with PSA levels of 4-10 ng/mL accompanied by a negative DRE finding.
authors.affiliation: Department of Urology, Okayama Central Hospital, Ishimakitamachi, Okayama, Japan. masami5@cf6.so-net.ne.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Watanabe
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hayashi
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Tsushima
authors.forename: Shin
authors.initials: S
authors.lastname: Irie
authors.forename: Tetsuzo
authors.initials: T
authors.lastname: Kaneshige
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012007:Rectum; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen