title: Characteristics and clinical significance of prostate cancers missed by initial transrectal 12-core biopsy.
abstract: OBJECTIVE
  • To characterize prostate cancers missed by initial transrectal 12-core biopsy.
  
  
  METHODS
  • Between 2002 and 2008, 715 men with prostate-specific antigen levels in the range 2.5-20 ng/mL or abnormal digital rectal examination underwent three-dimensional 26-core prostate biopsy (i.e. a combination of transrectal 12-core biopsy and transperineal 14-core biopsy) on initial examination. • Of the 257 patients diagnosed with cancer, 120 patients subsequently underwent radical prostatectomy. • Cancers were grouped into TR12-negative cancers (i.e. not detected through transrectal 12-core biopsy but detected through transperineal 14-core biopsy) and TR12-positive (i.e. detected through transrectal 12-core biopsy) cancers. • Clinicopathological characteristics of the TR12-negative and TR12-positive cancers were evaluated.
  
  
  RESULTS
  • TR12-negative cancers comprised 21% of the three-dimensional 26-core biopsy-detected cancers. • The frequency of cancers with a biopsy Gleason score ≤ 6 and that of cancers with a biopsy primary Gleason grade ≤ 3 was higher in TR12-negative cancers, at 58% and 83%, respectively, than in TR12-positive cancers, at 25% (P < 0.001) and 53% (P < 0.001), respectively. • The median number of positive cores in TR12-negative cancers was two out of 26. • TR12-negative cancers were more frequently located anteriorly than posteriorly. • The incidence of the TR12-negative cancers was not associated significantly with any clinical variable.
  
  
  CONCLUSIONS
  • Many of the cancers missed by initial transrectal 12-core biopsy are probably low-grade and low-volume diseases, although initial transrectal 12-core biopsy has a small but definite risk of missing anterior significant cancers.
authors.affiliation: Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. noboru.uro@tmd.ac.jp
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Mizuaki
authors.initials: M
authors.lastname: Sakura
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Iwao
authors.initials: I
authors.lastname: Fukui
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D012007:Rectum