Dr Whang comments: This article states that taking additional samples can increase detection of prostate cancer. I remember when it was 6 core biopsies and then we increased to 12 core biopsies with improved detection rate. Now it is 16 core biopsies. I also use 20 core biopsies (extended biopsy) in certain patients with high risk for cancer. For 20 core biopsies, I recommend sedation as it becomes more uncomfortable. I do not know the ideal number of cores to take. I do feel that MRI guidance is likely most helpful in detecting prostate cancer.
Sixteen cores better than 12 for prostate cancer detection
By Joanna Lyford, Senior medwireNews Reporter
21 July 2014
Urol J 2014; 3: 1609–1614
medwireNews: Sixteen-core prostate biopsy has a slightly higher cancer detection rate than 12-core biopsy, but with a similar safety profile and no increased detection of clinically insignificant tumours, study findings show.
The research was undertaken by Yasuhide Miyoshi (Yokohama City University, Japan) and team and included 332 men with prostate-specific antigen (PSA) levels in the range 4.0 to 20.0 ng/mL.
All patients underwent transrectal ultrasound-guided needle biopsy and removal of either 12 (n=195) or 16 (n=137) cores. The decision on how many cores to take was not randomised but instead reflected local protocols; thus, men in the 16-core group were significantly younger and had higher levels of PSA than those in the 12-core group.
Prostate cancer was detected in 33.8% of men who had 12 cores taken and in 44.5% of those with 16 cores; this difference did not reach statistical significance. However, 16-core biopsy found significantly more cancer than 12-core biopsy in two subgroups of men – those with a prostate volume greater than 30 mL (29.4 vs 15.5%) and those with a PSA density below 0.2 (34.0 vs 6.3%).
The anatomical distribution of detected cancers did not differ between the two biopsy methods; neither did the pathological tumour grade or proportion of cancers that were deemed to be clinically insignificant.
Importantly, periprocedural risks and complications were similar between the two approaches, with no instances of urinary tract infection and low rates of haematuria and urinary retention.
Writing in Urology Journal, Miyoshi and team admit that the optimum number of cores to be obtained on prostate biopsy remains unclear and can only be demonstrated definitively in a prospective, randomised trial.
Nevertheless, this study adds to previous work showing that extended prostate biopsies “are superior to sextant protocols” for detecting prostate cancer.
Furthermore, this study suggests that 12-core biopsy “may be inadequate in patients with large prostate volume or low PSA [density],” they write.
They conclude that “16-core prostate biopsy is safe and feasible for Japanese patients with serum PSA level of 4.0-20.0 ng/mL.”
“Further studies in different population with greater sample size are needed to draw final conclusion"
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014