title: The value of an additional hypoechoic lesion-directed biopsy core for detecting prostate cancer.
abstract: OBJECTIVE
  To determine the value of a hypoechoic lesion (HL)-directed biopsy in addition to a systematic sextant biopsy for detecting prostate cancer.
  
  
  METHODS
  Within the European Randomized study of Screening for Prostate Cancer, 37 627 assays for prostate-specific antigen (PSA) were done in men aged 55-75 years (screening round 1-3, interval 4 years). A PSA level of >or=3.0 ng/mL prompted a systematic transrectal ultrasonography (TRUS)-guided lateralized sextant biopsy (4986 biopsy sessions were evaluated). If there was a HL, an additional lesion-directed biopsy was taken.
  
  
  RESULTS
  At the initial screening, 1840 men were biopsied and 532 cancers were detected (28.9%). Of the men biopsied, 436 had a HL and an additional biopsy (23.7%). In these men, 230 cancers were detected (52.8%). In 3.5% (eight of 230) only the HL-directed core showed malignancy. At the repeat and third screening, respectively, 19.3% and 18.9% of the men biopsied had prostate cancer, 16.8% and 9.3% had an HL and the additional core detected two (2.2%) and one (5.9%) cancers. At the first screen most cancers found by the additional core were clinically relevant. In later screens these cancers seemed to be minimal.
  
  
  CONCLUSIONS
  The performance of TRUS as a screening tool is poor. The value of the additional core was limited as only 3.5% of the visible cancers were detected solely by the additional biopsy (round 1). However, a substantial part of these cancers were clinically relevant and would have been missed without the additional biopsy. This finding was less clear in screening round 2 and 3, even in men who were not previously biopsied.
authors.affiliation: Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. c.gosselaar@erasmusmc.nl
authors.forename: Claartje
authors.initials: C
authors.lastname: Gosselaar
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: Stijn
authors.initials: S
authors.lastname: Roemeling
authors.forename: Tineke
authors.initials: T
authors.lastname: Wolters
authors.forename: Geert J L H
authors.initials: GJ
authors.lastname: van Leenders
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods / Q000592:standards*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen