title: Prostate cancer detection rates in different biopsy schemes. Which cores for which patients?
abstract: OBJECTIVE
  To determine whether the addition of four paramedian peripheral and four lateral peripheral cores improves the cancer detection rate (CDR) of the extended 10-core biopsy scheme and which patients benefit most from such additional samples.
  
  
  METHODS
  One thousand and ninety-one consecutive patients scheduled for first ultrasound-guided transrectal prostate biopsy prospectively underwent a 18-core biopsy scheme, including the traditional sextant (6-core), 4 lateral peripheral (10-core), 4 paramedian peripheral (14-core) and additional 4 lateral peripheral cores (18-core).
  
  
  RESULTS
  The CDR of the 6-, 10-, 14- and 18-core schemes was 33.1, 39.2, 41.6 and 41.8 %, respectively; the difference between the 10- and 6-core scheme reached significance (p < 0.005), whereas that between the 18- or 14- and the 10-core scheme did not. The percentage of tumors diagnosed on the sole basis of the 14-core scheme was significantly greater in patients with low PSA (≤ 7.2 vs. >7.2 ng/ml: 12.1 vs. 1.8 %; p < 0.0001), large prostate volume (≥ 50 vs. <50 cc: 3.4 vs. 9.1 %; p = 0.011) and particularly low PSA density (<0.15 vs. ≥ 0.15: 15.9 vs. 1 %; p < 0.0001). The 18-core scheme did not provide diagnostic advantages in any patients' population.
  
  
  CONCLUSIONS
  The addition of 4 lateral peripheral samples did not increase the CDR of the 10-core biopsy scheme. The addition of four paramedian peripheral samples was beneficial only in patients with PSA density <0.15, in whom the 10-core scheme would have miss almost 16 % of tumors. Since more than half of our patients had low (<0.15) PSA density, these findings seem to be of great clinical relevance.
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110, Foggia, Italy, luigicormio@libero.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cormio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Lorusso
authors.forename: Antonia
authors.initials: A
authors.lastname: Perrone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Fino
authors.forename: Oscar
authors.initials: O
authors.lastname: Selvaggio
authors.forename: Francesca
authors.initials: F
authors.lastname: Sanguedolce
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Bufo
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrieri
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D007610:Kallikreins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D047368:Tumor Burden
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen