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Computer simulated additional deep apical biopsy enhances cancer detection in palpably benign prostate gland
Author(s) -
MATSUMOTO KAZUMASA,
EGAWA SHIN,
SATOH TAKEFUMI,
KURUMA HIDETOSHI,
YANAGISAWA NOBUYUKI,
BABA SHIRO
Publication year - 2006
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2006.01557.x
Subject(s) - medicine , prostate cancer , biopsy , prostate , cancer , urology , prostate biopsy , radiology
Objectives: The objective of this study was to use computer simulation to investigate the optimal biopsy scheme for enhancing the detection of cancer in palpably benign prostate glands. Methods: The predominant distribution of palpably benign prostate cancer is anterior apex to mid‐prostate. We used computer simulation to optimize apical samplings and to simulate the biopsy procedure, including angle and length. A total of 254 consecutive patients with palpably benign prostate glands underwent sextant biopsy plus two additional deep apical biopsies. Results: Based on the computer simulation, lateral sextant and two additional medially located deep apical cores with a sagittal penetration angle of 80° had the maximum cancer detection. Of the 254 patients, 58 (22.8%) had prostate cancer: 28 (48.3%) were positive only at the standard sextant sites, 12 (20.7%) were positive exclusively at the deep apical sites, and the remaining 18 (31.0%) were positive at both sites. Patients with gray‐zone prostate‐specific antigen (PSA) ranges of 4.1–10.0 ng/mL had increased cancer detection rates of 24% compared to sextant biopsy. Enhanced cancer detection by the deep apical biopsy was also evident in patients with a prostatic volume >40 cm 3 (by 36.4%) and PSA 2.1–4.0 ng/mL (by 13.3%). Conclusions: Using a computer simulation‐based biopsy scheme with deep apical sampling cores enhanced the detection of prostate cancer in palpably benign glands, especially in men with PSA ranges of 4.1–10.0 ng/mL or a gland volume of >40 cm 3 . Our approach with fewer sampling cores may have been more cost‐effective than other extensive biopsy schemes, but further studies with larger samples are warranted.