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The value of an additional hypoechoic lesion‐directed biopsy core for detecting prostate cancer
Author(s) -
Gosselaar Claartje,
Roobol Monique J.,
Roemeling Stijn,
Wolters Tineke,
Van Leenders Geert J.L.H.,
Schröder Fritz H.
Publication year - 2008
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.2007.07309.x
Subject(s) - medicine , biopsy , malignancy , prostate cancer , prostate , cancer , transrectal ultrasonography , prostate biopsy , prostate specific antigen , radiology , lesion , pathology
OBJECTIVE To determine the value of a hypoechoic lesion (HL)‐directed biopsy in addition to a systematic sextant biopsy for detecting prostate cancer. SUBJECTS AND METHODS Within the European Randomized study of Screening for Prostate Cancer, 37 627 assays for prostate‐specific antigen (PSA) were done in men aged 55–75 years (screening round 1–3, interval 4 years). A PSA level of ≥3.0 ng/mL prompted a systematic transrectal ultrasonography (TRUS)‐guided lateralized sextant biopsy (4986 biopsy sessions were evaluated). If there was a HL, an additional lesion‐directed biopsy was taken. RESULTS At the initial screening, 1840 men were biopsied and 532 cancers were detected (28.9%). Of the men biopsied, 436 had a HL and an additional biopsy (23.7%). In these men, 230 cancers were detected (52.8%). In 3.5% (eight of 230) only the HL‐directed core showed malignancy. At the repeat and third screening, respectively, 19.3% and 18.9% of the men biopsied had prostate cancer, 16.8% and 9.3% had an HL and the additional core detected two (2.2%) and one (5.9%) cancers. At the first screen most cancers found by the additional core were clinically relevant. In later screens these cancers seemed to be minimal. CONCLUSION The performance of TRUS as a screening tool is poor. The value of the additional core was limited as only 3.5% of the visible cancers were detected solely by the additional biopsy (round 1). However, a substantial part of these cancers were clinically relevant and would have been missed without the additional biopsy. This finding was less clear in screening round 2 and 3, even in men who were not previously biopsied.