title: Low risk patients benefit from extreme anterior apical sampling on initial biopsy for prostate cancer diagnosis.
abstract: BACKGROUND
  To assess the effect of additional extreme apical sampling on prostate cancer (PCa) detection and aggressiveness in patients with standard risk versus high risk of a positive biopsy.
  
  
  METHODS
  Three thousand fifty three men were reviewed from our institution review board approved prostate biopsy database. Two thousand five hundred and twenty one underwent biopsy with 12 cores while 532 underwent 14 core sampling (2 extra cores from the extreme anterior apex). Patients were stratified into one of two risk groups: (1) standard risk of PCa (elevated prostate specific antigen (PSA) < 10 ng/ml, normal digital rectal exam (DRE), and no lesions on transrectal ultrasound (TRUS)), and (2) higher risk of PCa (PSA > 10 ng/ml and/or abnormal DRE and/or lesion on TRUS). Prostate cancer detection and disease characteristics were compared between the biopsy schemes stratified by risk of a positive biopsy.
  
  
  RESULTS
  PCa detection with 14 core sampling was more likely in all patients (OR 1.339, 95% CL 1.070-1.676) and in men with standard risk (OR 1.334, 95% CL 1.007-1.769). A greater median number of positive cores (3 vs. 2) and a higher maximum cancer % per core (40% vs. 25%) were seen in the 14 core cohort when stratified to standard risk. Gleason ≥7 was more likely detected with 14 cores in the standard risk group (55.6% vs. 45.2%). Differences in PCa detection and Gleason ≥7 between biopsy techniques were not noted in the higher risk group.
  
  
  CONCLUSIONS
  Extreme apical sampling increases aggressive cancer detection on initial biopsy, especially in patients with standard risk of PCa.
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Urology, Al Kasr Al Aini School of Medicine, Cairo University, Cairo, Egypt.
authors: Ahmed
authors: A
authors: Elshafei
authors: Ganesh
authors: G
authors: Kartha
authors: Yonghong
authors: Y
authors: Li
authors: Ayman
authors: A
authors: S Moussa
authors: Asmaa
authors: A
authors: Hatem
authors: Tianming
authors: T
authors: Gao
authors: J Stephen
authors: JS
authors: Jones
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D000368:Aged; D001706:Biopsy / Q000379:methods; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013048:Specimen Handling / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: extreme apical sampling; prostate biopsy; prostate cancer diagnosis