Year : 2006 | Volume
: 22 | Issue : 3 | Page : 282--283
Best method to biopsy the prostate
N Gupta, A Srivastava
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow
|How to cite this article:|
Gupta N, Srivastava A. Best method to biopsy the prostate.Indian J Urol 2006;22:282-283
|How to cite this URL:|
Gupta N, Srivastava A. Best method to biopsy the prostate. Indian J Urol [serial online] 2006 [cited 2019 Sep 21 ];22:282-283
Available from: http://www.indianjurol.com/text.asp?2006/22/3/282/27649
Several biopsy techniques have been proposed for the diagnosis of prostate cancer especially the extended techniques with more than six cores. This article has systematically compared the cancer detection rates and complications of different extended prostate biopsy schemes to identify the optimal scheme. A total of 68 studies that compared different systematic prostate biopsy methods using sequential sampling or a randomized design in men scheduled for biopsy due to suspected prostate cancer were included and analyzed. It was found that an increasing number of cores were significantly associated with the cancer yield. Laterally directed cores increased the yield significantly ( P = 0.003), whereas centrally directed cores did not. Schemes with 12 cores that took additional laterally directed cores detected 31% more cancers than the sextant scheme. Schemes with 18 to 24 cores did not detect significantly more cancers. Adverse events for schemes up to 12 cores were similar to those for the sextant pattern. Adverse event reporting was poor for schemes with 18 to 24 cores. Thus prostate biopsy using 12 cores including the laterally directed cores strikes the balance between cancer detection rates and adverse events.
For many years the systematic sextant biopsy protocol, a fixed pattern with six cores from the paramedian prostate regions, has been the standard procedure, however, several new extended prostate biopsy schemes to confirm cancer in men with a positive PSA test result and/or positive digital rectal examination have been discussed recently. This article systematically reviews the literature to compare the cancer detection rates and complications of different extended prostate biopsy schemes for diagnostic evaluation in men scheduled for biopsy. Adopting strict inclusion criteria of including only the studies that compared the two schemes i.e., standard and the extended in the same population, is a strong point of this review. A five-region anatomical model has been used to compare the standard and the extended biopsy schemes and grouping of various schemes has been done on the basis of number and pattern of cores. This review brings to light the poor reporting of adverse events by primary studies and the insufficient evidence to determine whether extended biopsy schemes increase the rate of major adverse events. The article however highlights the importance of taking at least 12 cores including laterally directed cores to optimize cancer detection rate in ca prostate.