Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review.
OBJECTIVE
Several new extended prostate biopsy schemes (greater than 6 cores) have been proposed. We compared the cancer detection rates and complications of different extended prostate biopsy schemes for diagnostic evaluation in men scheduled for biopsy to identify the optimal scheme.


METHODS
In a systematic review we searched 13 electronic databases, screened relevant urological journals and the reference lists of included studies, and contacted experts. We included studies that compared different systematic prostate biopsy methods using sequential sampling or a randomized design in men scheduled for biopsy due to suspected prostate cancer. We pooled data using a random effects model when appropriate.


RESULTS
We analyzed 87 studies with a total of 20,698 patients. We pooled data from 68 studies comparing a total of 94 extended schemes with the standard sextant scheme. An increasing number of cores were significantly associated with the cancer yield. Laterally directed cores increased the yield significantly (p = 0.003), whereas centrally directed cores did not. Schemes with 12 cores that took additional laterally directed cores detected 31% more cancers (95% CI 25 to 37) than the sextant scheme. Schemes with 18 to 24 cores did not detect significantly more cancers. Adverse events for schemes up to 12 cores were similar to those for the sextant pattern. Adverse event reporting was poor for schemes with 18 to 24 cores.


CONCLUSIONS
Prostate biopsy schemes consisting of 12 cores that add laterally directed cores to the standard sextant scheme strike the balance between the cancer detection rate and adverse events. Taking more than 12 cores added no significant benefit.
Eichler
Klaus
K
Horten Centre, Zurich University, Zurich, Switzerland. klaus.eichler@evimed.ch
Hempel
Susanne
S
Wilby
Jennifer
J
Myers
Lindsey
L
Bachmann
Lucas M
LM
Kleijnen
Jos
J
D001706:Biopsy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results