title: Computer simulated additional deep apical biopsy enhances cancer detection in palpably benign prostate gland.
abstract: OBJECTIVE
  The objective of this study was to use computer simulation to investigate the optimal biopsy scheme for enhancing the detection of cancer in palpably benign prostate glands.
  
  
  METHODS
  The predominant distribution of palpably benign prostate cancer is anterior apex to mid-prostate. We used computer simulation to optimize apical samplings and to simulate the biopsy procedure, including angle and length. A total of 254 consecutive patients with palpably benign prostate glands underwent sextant biopsy plus two additional deep apical biopsies.
  
  
  RESULTS
  Based on the computer simulation, lateral sextant and two additional medially located deep apical cores with a sagittal penetration angle of 80 degrees had the maximum cancer detection. Of the 254 patients, 58 (22.8%) had prostate cancer: 28 (48.3%) were positive only at the standard sextant sites, 12 (20.7%) were positive exclusively at the deep apical sites, and the remaining 18 (31.0%) were positive at both sites. Patients with gray-zone prostate-specific antigen (PSA) ranges of 4.1-10.0 ng/mL had increased cancer detection rates of 24% compared to sextant biopsy. Enhanced cancer detection by the deep apical biopsy was also evident in patients with a prostatic volume >40 cm3 (by 36.4%) and PSA 2.1-4.0 ng/mL (by 13.3%).
  
  
  CONCLUSIONS
  Using a computer simulation-based biopsy scheme with deep apical sampling cores enhanced the detection of prostate cancer in palpably benign glands, especially in men with PSA ranges of 4.1-10.0 ng/mL or a gland volume of >40 cm3. Our approach with fewer sampling cores may have been more cost-effective than other extensive biopsy schemes, but further studies with larger samples are warranted.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. kazumasa@cd5.so-net.ne.jp
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Shin
authors.initials: S
authors.lastname: Egawa
authors.forename: Takefumi
authors.initials: T
authors.lastname: Satoh
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kuruma
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yanagisawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D003198:Computer Simulation; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011470:Prostatic Hyperplasia / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies