title: The optimal number of initial prostate biopsy cores in daily practice: a prospective study using the Nara Urological Research and Treatment Group nomogram.
abstract: BACKGROUND
  To elucidate the optimal number of prostate biopsy cores using a nomogram allocating 6-12 biopsy cores, the number generally used in daily practice, based on age and prostate volume (PV).
  
  
  METHODS
  We enrolled 936 patients who received an initial prostate biopsy from April 2006 to January 2009. A number of 6-12 biopsy cores was allocated based on age and PV Nara Urological Research and Treatment Group (NURTG) nomogram. To elucidate the predictive parameters of cancer detection in patients with a prostate specific antigen (PSA) value in the gray zone, univariate and multivariate logistic regression analysis were carried out.
  
  
  RESULTS
  The total cancer detection rate and the cancer detection rate in the PSA gray zone (4.1-10.0 ng/mL) were 48.0 and 37.6 %, respectively. The cancer detection rates in the gray zone stratified by patient age of ≤59, 60-64, 65-69, 70-74, 75-79, and ≥80 years were 28.4, 35.0, 26.9, 37.9, 45.7, and 54.8 %, respectively. The significant predictive parameters of cancer detection in the gray zone were age, volume biopsy ratio (VBR: PV divided by number of biopsy cores), PSA density (PSAD), digital rectal examination findings, and transrectal ultrasound findings in univariate analyses. Finally, age, VBR, and PSAD were independent parameters to predict cancer detection in the gray zone. The adverse event profile was acceptable.
  
  
  CONCLUSIONS
  Our present study revealed that the cancer detection rate using the NURTG nomogram allocating 6-12 biopsy cores, the number generally used in daily practice, based on age and PV, could provide similar efficacy as previous studies involving more biopsy cores. In older patients the number of biopsy cores could be reduced.
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. sendo@naramed-u.ac.jp.
authors.forename: Nobumichi
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Pathology, Nara Medical University, Kashihara, Nara, Japan. keijishi@naramed-u.ac.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Nara Urological Research and Treatment Group, Kashihara, Nara, Japan. nakagawa@ym-hp.yamatotakada.nara.jp.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Nara Urological Research and Treatment Group, Kashihara, Nara, Japan. CJ8S-HRO@asahi-net.or.jp.
authors.forename: Shuya
authors.initials: S
authors.lastname: Hirao
authors.affiliation: Nara Urological Research and Treatment Group, Kashihara, Nara, Japan. watanabe@chuwa-hp.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. makitomiyake@yahoo.co.jp.
authors.forename: Makito
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. sanai@naramed-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Anai
authors.affiliation: Nara Urological Research and Treatment Group, Kashihara, Nara, Japan. hirayamn@nara.med.kindai.ac.jp.|Department of Urology, Nara Hospital Kinki University Faculty of Medicine, Ikoma, Nara, Japan. hirayamn@nara.med.kindai.ac.jp.
authors.forename: Akihide
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: Department of Pathology, Nara Medical University, Kashihara, Nara, Japan. nkonishi@naramed-u.ac.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Konishi
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. kiyokun@naramed-u.ac.jp.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005334:Fever / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D017430:Prostate-Specific Antigen