title: Biopsy of the anterior prostate gland: technique with end-fire transrectal ultrasound.
abstract: OBJECTIVE
  Transperineal approach is considered the best method to biopsy the anterior tissue of the prostate gland that is generally neglected by transrectal approach. We describe a technique of anterior prostate biopsy obtained with transrectal approach using an end-fire probe.
  
  
  METHODS
  We correlated the images of the video of the diagnostic biopsy, the histology of the biopsy and of the surgical specimen after radical prostatectomy. A 68 years old may previously underwent two biopsies: first biopsy and re-biopsy were performed using the transrectal approach with 12 and 16 cores respectively, including the tranisizion zone (2 per side). Initial histology revealed high grade PIN only. We performed a saturation biopsy (28 samples) under local anesthesia, as outpatient, using endfire ultrasound probe, including anterior zone and fibromuscolar stroma (2 per side). Images of the procedure was stored electronically. Each biopsy core was pre-embedded and inked at one side in order to identify the rectal end (pericapsular side). Surgical specimen of radical nerve sparing prostatectomy was analyzed according to the Stanford protocol (3 mm). All biopsies and surgical specimens were reviewed by the same uro-pathologist.
  
  
  RESULTS
  Cancer was detected only by anterior biopsy (left side, 1 core, 3 mm of total cancer extension, Gleason score 3 + 3, placed into the not inked core side). Histology of the surgical specimen confirmed the location of the disease with 0.3 cc tumor volume. Technically, to improve biopsy of the anterior zone the tip of the needle should obtain all the tissue up to the Santorini venous plexus. Postoperative recovery was uneventful after both procedures.
  
  
  CONCLUSIONS
  We showed that end-fire probe makes possible, effective and safe the biopsy of the anterior prostate, which may contain cancer in particular when previous biopsies are negative. The anterior biopsy technique herein described is easy and reliable. Based on our experience, end-fire probe should be used in re-biopsy or saturation biopsy if transrectal approach is preferred. Confirmatory randomized clinical trial should be done in the future.
authors.affiliation: Institute of Urology, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. galosiab@yahoo.it
authors.forename: Andrea Benedetto
authors.initials: AB
authors.lastname: Galosi
authors.forename: Marco
authors.initials: M
authors.lastname: Tiroli
authors.forename: Daniele
authors.initials: D
authors.lastname: Cantoro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Conti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muzzonigro
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D018084:Ultrasonography, Interventional