title: Additional Midline Biopsies of the Peripheral Zone Associated with the First Endorectal Standard Sextant Pattern Improves the Accuracy of Prostate Cancer Detection in Japanese Patients.
abstract: OBJECTIVE
  This study was designed to estimate the improved accuracy of prostate cancer (PCa) detection resulting from additional midline biopsies of the peripheral zone in first standard biopsy.
  
  
  METHODS
  Patients were classified into 3 groups: 402 cases of sextant biopsies (1995-2002), 488 cases of 8-core biopsies with 2 additional midline biopsies (2003-2006), and 391 cases of 10-core biopsies with 4 additional midline biopsies (2007-2012). The positive rate of each number of biopsies and changes in positive rates associated with prostate specific antigen (PSA) ranges were estimated.
  
  
  RESULTS
  The positive rate of core biopsy significantly improved with increasing numbers of core biopsies (30.1% for sextant, 43.4% for 8-core biopsies, and 53.1% for 10-core biopsies). The accuracy of biopsies for each PSA range also significantly improved (22.3% for sextant, 30.0% for 8-core biopsies, and 43.2% for 10-core biopsies in the PSA gray zone [4.01-10 ng/ml]; and 26.5% for sextant, 52.9% for 8-core biopsies, and 71.8% for 10-core biopsies in the intermediate PSA range [10.1-20 ng/ml]). In the 208 cases with positive results using the 10-core biopsy method, the distribution of Gleason scores did not differ between the sextant only group and the midline site only group.
  
  
  CONCLUSIONS
  Additional midline biopsy was associated with improved accuracy of positive core biopsies in Japanese patients with a PSA range of 4.01-20 ng/ml. © 2015 S. Karger AG, Basel.
authors.affiliation: Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Norihito
authors.initials: N
authors.lastname: Soga
authors.affiliation: Department of Pathology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.affiliation: Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Hayashi
keywords: Additional midline; Diagnosis accuracy; First endorectal biopsy; Prostate cancer; Systematic biopsy