title: Role of transperineal six-core prostate biopsy in patients with prostate-specific antigen level greater than 10 ng/mL and abnormal digital rectal examination findings.
abstract: OBJECTIVE
  To define whether six-core biopsies still have a role in patients presenting with prostate-specific antigen (PSA) levels greater than 10 ng/mL and abnormal digital rectal examination (DRE) findings. Recent studies have suggested that the six-core biopsy is inadequate for the diagnosis of prostate cancer; however, it remains controversial whether an increased number of cores is justified in all patients.
  
  
  METHODS
  From June 2002 to February 2005, 122 (18.8%) of 650 patients underwent prostate biopsy because of a PSA level greater than 10 ng/mL and abnormal DRE findings. All patients underwent transperineal ultrasound-guided prostate biopsy in a standardized fashion: a six-core biopsy was performed first, followed by six additional cores during the same session, four in the peripheral and two in the transition zone.
  
  
  RESULTS
  The detection rate in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings was 72.1% (88 of 122) and 75.4% (92 of 122) using the 6-core and 12-core biopsy, respectively. One case of tumor was missed by the six-core biopsy among patients with a PSA level greater than 15 ng/mL and abnormal DRE findings. No cases of tumor were missed by six-core biopsy in the group with a PSA level greater than 20 ng/mL and abnormal DRE findings.
  
  
  CONCLUSIONS
  Six-core biopsy provided a similar cancer detection rate compared with 12-core biopsy in patients with PSA levels greater than 10 ng/mL and abnormal DRE findings. An initial approach with 6-core biopsy is reasonable in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings and is advocated in those with PSA greater than 20 ng/mL and abnormal DRE findings.
authors.affiliation: Department of Urology, S.M. Misericordia Hospital/University of Udine, Udine, Italy. lorenzo_luciani@hotmail.com
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Luciani
authors.forename: Gioacchino
authors.initials: G
authors.lastname: De Giorgi
authors.forename: Claudio
authors.initials: C
authors.lastname: Valotto
authors.forename: Martina
authors.initials: M
authors.lastname: Zanin
authors.forename: Sergio
authors.initials: S
authors.lastname: Bierti
authors.forename: Filiberto
authors.initials: F
authors.lastname: Zattoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*
chemical_list: D017430:Prostate-Specific Antigen