Adult urologyParasagittal biopsies add minimal information in repeat saturation prostate 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.
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