title: Incremental value of transition zone and midline apical biopsy at baseline TRUS-guided biopsy for prostate cancer detection.
abstract: OBJECTIVE
  To determine the diagnostic yield of transition zone (TZB) and midline apical biopsies (MAB) in baseline transrectal ultrasound (TRUS)-guided biopsies and to establish whether TZB and MAB for the diagnosis of prostate cancer (PCa) add clinical relevant information.
  
  
  METHODS
  We performed baseline 9-core TRUS-guided biopsy in 412 consecutive subjects using sextant biopsies of the PZ (PZB), with an additional TZB on either side and a MAB at the prostatic apex. We determined the incremental diagnostic value of additional TZB an MAB to sextant PZB.
  
  
  RESULTS
  Within a cohort of 412 patients with a median PSA of 7.5 ng/ml, 178 (43.2 %) patients were diagnosed with PCa upon baseline TRUS-guided biopsies. In 102 cases, at least one TZB was positive for PCa, with 6/412 (1.4 %) cases displaying PCa in the TZB only. MAB alone was positive for PCa in 4/412 (1.0 %) cases. One case (1/412; 0.2 %) had only a TZB and a MAB positive for PCa without positive PZB. Thus, 11/412 (2.7 %) of cases would not have been diagnosed with PCa at baseline TRUS-guided biopsy had only sextant PZ biopsy been performed. TZB detected a high-grade Gleason component (Gleason 4 and/or 5) not present in the PZB in 2.4 % of PCa cases.
  
  
  CONCLUSIONS
  There is limited value for TZB and MAB in the context of sextant PZB at baseline TRUS-guided biopsies for PCa.
authors.affiliation: Department of Urology (B28), Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands, r.somford@cwz.nl.
authors.forename: D M
authors.initials: DM
authors.lastname: Somford
authors.forename: W
authors.initials: W
authors.lastname: Vreuls
authors.forename: T S
authors.initials: TS
authors.lastname: Jansen
authors.forename: J P
authors.initials: JP
authors.lastname: van Basten
authors.forename: H
authors.initials: H
authors.lastname: Vergunst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D061705:Image-Guided Biopsy; D007610:Kallikreins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen