Premium
Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity
Author(s) -
Mariappan Paramananthan,
Chong Wooi Loong,
Sundram Murali,
Mohamed Sahabudin R.
Publication year - 2004
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2004.04928.x
Subject(s) - medicine , biopsy , prostate cancer , prostate biopsy , rectal examination , prostate , transrectal ultrasonography , urology , prospective cohort study , randomized controlled trial , prostate specific antigen , radiology , cancer , surgery
OBJECTIVE To determine if a volume‐adjusted increase in the number of biopsy cores could detect more prostate cancers than the standard sextant biopsy alone, without increasing morbidity, and to determine its applicability in Malaysian patients, as a standard sextant biopsy misses 20–25% of prostate malignancies. PATIENTS AND METHODS In a prospective randomized study of patients undergoing transrectal ultrasonography (TRUS)‐guided biopsy for a prostate‐specific antigen (PSA) level of 4–20 ng/mL without abnormal digital rectal examination (DRE), the men were divided into five main groups (A–E) with prostate volumes of <20, 20–40, 40–60, 60–80 and >80 mL, respectively. Patients in groups B–E were randomized into sextant (B1 to E1) and increased biopsy‐core subgroups, i.e. B2 (eight cores), C2 (10 cores), D2 (12 cores) and E2 (14 cores). The morbidity profile was also evaluated during and after TRUS biopsy, assessing a pain score, rectal bleeding, haematuria, haemospermia and development of fever. In all, 132 patients were recruited (mean age 67.8 years; mean PSA 9.41 ng/mL). RESULTS The overall cancer detection rate was 24% (32 men). Taking more cores detected 65.5% of cancers, and the sextant biopsy 34.5% ( P = 0.0025), but did not increase the overall morbidity. CONCLUSIONS The volume‐adjusted, increased‐core regimen significantly increased the positive biopsy rate of TRUS‐guided prostate biopsies with no added morbidity.