Journal List > Korean J Urol > v.47(11) > 1069783

Kim, Lee, and Jeong: The Effectiveness of 12 Core Biopsy Protocol according to Prostate-specific Antigen (PSA) Level and Prostate Volume

Abstract

Purpose

The purpose of our study was to evaluate the effectiveness of the 12 core biopsy protocol in detecting prostate cancer by comparison with that of the 6 core biopsy according to the prostate-specific antigen (PSA) level and prostate volume.

Materials and Methods

Between January 2000 and April 2005, transrectal ultrasound-guided prostate biopsies were performed on 1,100 men suspected of prostate cancer. Biopsy cores were taken from 12 sites, consisting of the routine sextant cores and 6 additional cores from the far lateral areas (lateral apex, mid-lobe and base). The protocol with cores taken from all 12 sites was defined as the '12 core biopsy protocol' and the protocol with cores taken from the medial 6 sites only as the '6 core biopsy protocol'. The cancer detection rates of the two methods were analyzed according to the PSA level and prostate volume.

Results

The cancer detection rates were 30.6 (337/1,100) and 25.7% (283/1,100) for the 12 and 6 core biopsy protocols, respectively. The patients were stratified into 3 groups according to their PSA level, and another 3 groups according to their prostate volume. The detection rates of the 12 core biopsy protocol were higher in all groups. The patients were stratified into a further 9 groups according to both their PSA level and prostate volume. The 12 core biopsy protocol proved to be more effective than the 6 core biopsy protocol in most groups, with the exception of groups with a relatively low PSA and large prostate volume and those with a relatively high PSA and small prostate volume. Furthermore, when stratified by the PSA density (PSAD), the 12 core biopsy protocol showed higher detection rates in patients with levels between 0.05 and 0.3.

Conclusions

These results show that the detection rate of the 12 core biopsy protocol is higher in most groups, with the exception of groups with an extremely low or high PSAD, which suggests the PSAD may be a useful factor in determining the number of cores required for a prostate biopsy.

Figures and Tables

Table 1
Characteristics of the patients
kju-47-1166-i001

PSA: prostate-specific antigen, PV: prostate volume

Table 2
Detection rate of the 12 core biopsy
kju-47-1166-i002
Table 3
The detection rate of prostate cancer according to the PSA level
kju-47-1166-i003

PSA: prostate-specific antigen

Table 4
The detection rate of prostate cancer according to the prostate volume
kju-47-1166-i004

PV: prostate volume

Table 5
The detection rate of prostate cancer according to both the PSA level and prostate volume
kju-47-1166-i005

PSA: prostate-specific antigen, PV: prostate volume

Table 6
The detection rate of prostate cancer according to the PSA density
kju-47-1166-i006

PSA: prostate-specific antigen, PSAD: PSA density

References

1. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989. 142:71–74.
2. Naughton CK, Smith DS, Humphrey PA, Catalona WJ, Keetch DW. Clinical and pathologic tumor characteristics of prostate cancer as a function of the number of biopsy core: a retrospective study. Urology. 1998. 52:808–813.
3. Levine MA, Ittman M, Melamed J, Lepor H. Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostse cancer. J Urol. 1998. 159:471–475.
4. Stamey TA. Making the most out of six systematic sextant biopsies. Urology. 1995. 45:2–12.
5. Eskew LA, Bare RL, McCullough DL. Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol. 1997. 157:199–202.
6. Stewart CS, Leibovich BC, Weaver AL, Lieber MM. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol. 2001. 166:86–91.
7. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R, et al. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol. 2000. 163:152–157.
8. Presti JC Jr, Chang JJ, Bhargava V, Shinohara K. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol. 2000. 163:163–166.
9. Ravery V, Goldblatt L, Royer B, Blanc E, Toublan M, Bocon-Gibod L. Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol. 2000. 164:393–396.
10. Stricker HJ, Ruddock LJ, Wan J, Belville WD. Detection of non-palpable prostate cancer. A mathematical and laboratory model. Br J Urol. 1993. 71:43–46.
11. Seong DH, Cho JS, Hong SJ, Chung BH, Choi YD, Kim SJ, et al. The influence of age and prostate volume on the cancer detection rate in Korean men with PSA levels of 4.0 to 10.0 ng/ml: a multicenter, retrospective study. Korean J Urol. 2006. 47:353–357.
12. Norberg M, Egevad L, Holmberg L, Sparen P, Norlen BJ, Busch C. The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology. 1997. 50:562–566.
13. Lee SB, Kim CS, Ahn HJ. Comparative analysis of sextant and extended prostate biopsy. Korean J Urol. 2004. 45:524–529.
14. Moon KH, Cheon SH, Kim CS. Systematic 10-site prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. Korean J Urol. 2000. 41:1178–1182.
15. Presti JC Jr, O'Dowd GJ, Miller MC, Mattu R, Veltri RW. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancerrates: results of a community multi-practice study. J Urol. 2003. 169:125–129.
16. Bae KS, Chang SG. Comparative analysis between sextant biopsy and 12-samples needle biopsy for detection of stage T1c prostate cancer. Korean J Urol. 2004. 45:653–657.
17. Durkan GC, Sheikh N, Johnson P, Hildreth AJ, Greene DR. Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol. BJU Int. 2002. 89:33–39.
18. Park HK, Byun SS, Sohn DW, Hong SK, Lee ES, Lee SE, et al. The efficacy of 12-site biopsy protocol in men with elevated serum prostate-specific antigen level only. Korean J Urol. 2005. 46:463–466.
19. Naughton CK, Miller DC, Mager DE, Ornstein DK, Catalona WJ. A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol. 2000. 164:388–392.
20. Lee SC, Lee SC, Kim WJ. Value of PSA density, PSA velocity and percent free PSA for detection of prostate cancer in patients with serum PSA 4-10ng/ml patients. Korean J Urol. 2004. 45:747–752.
21. Naughton CK, Ornstein DK, Smith DS, Catalona WJ. Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol. 2000. 163:168–171.
TOOLS
Similar articles