Is transition zone sampling at repeated saturation prostate biopsy still useful?
OBJECTIVE
To evaluate retrospectively the detection rate of prostate cancer (PCa) located only in the transition zone (TZ) by directed cores at repeated saturation prostate biopsy (SPB).


METHODS
From July 2001 to December 2009, 380 and 43 patients (median age: 63 years) underwent second and third SPB because they were persistently suspicious for PCa. Indications for biopsy were: prostate-specific antigen (PSA) of >10 ng/ml, and PSA between 4.1 and 10 ng/ml or 2.6 and 4 ng/ml with free/total PSA of ≤25 and ≤20%, respectively. A median of 23 cores were taken in the posterior zone, including 3 (median) cores in the TZ. The median PSA was 12.8 and 19.5 ng/ml and the digital rectal examination was positive in 36 (9.5%) and in no cases at second and third SPB, respectively. In patients with persistent and/or increasing PSA or abnormal free/total PSA values after negative second and third SPB, a transurethral prostate resection (TURP) was suggested to avoid the risk of missing a cancer localized in the TZ.


RESULTS
PCa was detected in the TZ only in 2/82 cases (2.5%), and in details in 1/79 (1.2%) and 1/3 (33.3%) of the men diagnosed at second and third SPB, respectively. After TURP, a PCa was found in 18/95 men (18.9%; 14 stage T1a and 4 stage T1b) and in 3/15 men (20%; 2 stage T1a and 1 stage T1b) previously having had negative second and third SPB.


CONCLUSIONS
Sampling from the prostatic TZ by directed needle biopsies at repeated SPB was associated with a very low incidence of PCa (2.5%), especially if compared to TURP (19% detection rate), and could be omitted.
Pepe
Pietro
P
Department of Urology, Cannizzaro Hospital, Catania, Italy. piepepe @ hotmail.com
Candiano
Giuseppe
G
Fraggetta
Filippo
F
Galia
Antonio
A
Grasso
Giuseppe
G
Aragona
Francesco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D011467:Prostate / Q000473:pathology* / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D012306:Risk; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D014572:Urology / Q000379:methods
D017430:Prostate-Specific Antigen