7 to 10 years' follow-up of 573 patients with elevated prostate-specific antigen (>4 ng/mL) or/and suspected rectal examination: biopsies protocol and follow-up guides.
OBJECTIVE
In this study, we tried to design a scheme for performing transrectal ultrasonographic (TRUS)-biopsies that would be accurate and include the optimal number of cores.


METHODS
We included in this study 600 consecutive patients with suspicious findings on a per-rectum examination and/or an elevated prostate-specific antigen (PSA) (>4 ng/mL) level. Patients were followed for 7 to 10 years. In all patients, we took from 8 to 16 biopsy samples, according to the prostate volume, from the lateral aspects. In the second session, the biopsy samples were taken medially; in the third session, we included the transitional zone, while in consecutive sessions, we increased the number of cores from all areas.


RESULTS
Only 573 of the patients remained in follow-up. TRUS-biopsy detected prostate cancer (PCa) in 257 patients (44.85% overall detection rate). The detection rate in the first and second sessions was 32.98% and 14.94%, respectively, reaching 13.2% and 2.17%, in the third and fourth sessions, respectively. Prostate volumes were significantly smaller (52.9 +/- 22.4 cc vs 58.9 +/- 23.8 cc, P < 0.002) and the PSA/adenoma/prostate volumes ratio (ad-pro) ratio was higher (18.3 +/- 9 vs 13.96, P < 0/001) in the patients with PCa. Patients with PCa underwent fewer biopsy procedures and biopsy sessions than patients without a diagnosis of PCa (14.9 +/- 8.9 vs 20.4 +/- 12, P < 0.001;1.3 +/- 0.6 vs 1.7 +/- 0.9, P < 0.001). Biopsy samples obtained from the base were positive for cancer only in larger prostates with a mean volume of 54.3 +/- 15.3 cc. Numbers of biopsy procedures and PSA/ad-pro ratio were the strongest predictive factors for PCa detection (P < 0.001).


CONCLUSIONS
In patients with a prostate volume >or=53 cc and PSA/ad-pro ratio >or=18, the optimal biopsy cores should be >or=15. Using this scheme, the discontinuation of biopsy procedures might be considered after three consecutive sessions.
Kravchick
Sergey
S
Department of Urology, Barzilai Medical Center, Ashkelon, Israel. cambell@netvision.net.il
Cytron
Shmuel
S
Stepnov
Eugeny
E
Ben-Dor
David
D
Kravchenko
Yakov
Y
Peled
Ronit
R
D000368:Aged; D001706:Biopsy; D055088:Early Detection of Cancer; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology*; D012044:Regression Analysis; D014463:Ultrasonography
D017430:Prostate-Specific Antigen