Elsevier

Urology

Volume 63, Issue 1, January 2004, Pages 87-89
Urology

Adult urology
Parasagittal biopsies add minimal information in repeat saturation prostate biopsy

https://doi.org/10.1016/j.urology.2003.08.040Get rights and content

Abstract

Objectives

To compare the outcome and efficacy of lateral biopsies with parasagittal biopsies in detecting prostate cancer during repeated biopsies performed using the “saturation” technique, which includes 24 cores per biopsy. Prostate biopsy may miss cancer in up to 38% of men eventually found to harbor the disease. Lateral biopsies are more likely than parasagittal biopsies to detect adenocarcinoma according to the findings of several studies.

Methods

A total of 100 patients, average age 62.1 ± 7.9 years, underwent repeated transrectal ultrasound-guided saturation biopsy. The study group included 31 patients with previous biopsy results demonstrating high-grade prostatic intraepithelial neoplasia, 7 with atypia, and 62 with benign prostatic tissue but persistently elevated prostate-specific antigen levels. Patients had undergone an average of 1.65 previous biopsies. The average prostate-specific antigen level was 9.4 ± 6.8 ng/mL. Biopsies were obtained from five sectors on each side and examined histologically.

Results

Cancer was detected in 25 (25%) of the 100 patients. Malignancy was identified in the lateral cores of all patients with positive biopsies. Parasagittal biopsy cores were positive in association with a lateral-based biopsy in 9 (36%) of the 25 malignancies, for an overall parasagittal biopsy core rate of 9% (9 of 100 patients). No cancers were detected in the parasagittal biopsy cores alone.

Conclusions

Inclusion of parasagittal zone biopsy cores proved to have a low yield in detecting cancer on repeated biopsy. As all patients found to have cancer in the parasagittal biopsy cores also had cancer on the lateral biopsy cores, most time and effort can be spent obtaining lateral biopsy cores to increase the sensitivity on repeated saturation biopsy.

Section snippets

Material and methods

From February 2002 to July 2003, a total of 100 patients underwent repeated transrectal ultrasound-guided saturation biopsy. The institutional review board approved the study of the patient database. All patients included in the study provided informed consent. The average patient age was 62.1 ± 7.9 years. All patients had undergone at least one previous negative prostate biopsy. The patient population had undergone an average of 1.65 previous biopsies (range 1 to 7). The indications for repeat

Results

Prostate adenocarcinoma was detected in 25 (25%) of the 100 patients. All patients had Stage T1c cancer. Of the cancers detected, 2 were Gleason score 5, 17 were Gleason score 6, 5 were Gleason score 7, and 1 was Gleason score 9.

All cancers were detected in the lateral regions of the prostate (lateral base, lateral mid-section, or apex). Only 9 (36%) of the 25 cancers were also found in the parasagittal regions of the prostate, with no cancer detected exclusively in the parasagittal region. The

Comment

Repeat prostate biopsy may be indicated for patients with prior negative biopsies who have persistently elevated PSA levels, prostatic intraepithelial neoplasia, or atypia. Many studies have shown the efficacy of repeated biopsy within those patient populations.1, 9, 10, 11, 12, 13 The approach to biopsy has been a continuing debate.

Stamey4 stated that laterally directing sextant biopsies increased the detection rate of prostate cancer. Since then, numerous studies have looked at cancer

Conclusions

The results of this study have shown that parasagittal biopsies provide a low yield on repeat prostate biopsy after an initial negative biopsy. Parasagittal biopsies may still be important for first-time prostate biopsies. The present study did not address the likelihood of detecting cancer in the parasagittal cores during a first-time biopsy. However, during repeated biopsy, more time and effort can be spent on lateral biopsies, which should increase the cancer detection rate.

Cited by (78)

  • Regional suitability of climate-responsive technologies for buildings based on expert knowledge: A China study

    2018, Journal of Cleaner Production
    Citation Excerpt :

    To complement climate-responsive technologies for buildings, 15 experts from construction enterprises or academic institutions were then interviewed face-to-face from January to March 2017. Extra cases were also studied for more according to the principle of information saturation (Patel et al., 2004). Finally, 71 climate-responsive technologies for buildings to control temperature, humidity, sunlight, and ventilation were comprehensively identified based on bibliometric analysis, expert interview and case study.

  • Potential benefit of transrectal saturation prostate biopsy as an initial biopsy strategy: Decreased likelihood of finding significant cancer on future biopsy

    2014, Urology
    Citation Excerpt :

    On the basis of our publications identifying no unique cancer detection in parasagittal cores from these sectors, we omitted 4 medial cores. This yielded of a 20-core scheme focused on the lateral and apical gland.14 The uropathology team reviewed all cores.

  • Ultrasound-guided biopsy of the prostate: New updates

    2014, Ultrasound Clinics
    Citation Excerpt :

    Although saturation biopsy shows more accurate results than 12-core systematic biopsy in detection of prostate cancer, because of increased number of biopsy cores, this technique should be reserved for repeat biopsy in the setting of negative results on initial biopsy with suspicion of prostate cancer. The rate of detection of prostate cancer on saturation biopsies is 29% to 41% in patients with a suspicion for cancer and previous negative biopsies.59–61 Even saturation biopsies may miss significant cancers.62

View all citing articles on Scopus
View full text