396 REPEAT PROSTATE BIOPSY: COMPARISON OF CANCER DETECTION BETWEEN THE 24 CORE SATURATION BIOPSY SCHEME AND 2 DIFFERENT 12 CORE SCHEMES

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The yield of saturation prostate biopsy in patients with previous multiple negative biopsies

Repeat prostate biopsy and PSA kinetic in men with previous 3 or more PSA measurements

Stav K.1, Sandbank J.2, Leibovici D.1, Siegel Y.1, Lindner A.1, Zisman A.1

Benecchi L., Potenzoni M., Pieri A.M.

Assaf Harofeh Medical Center, Urology, Zeriffin, Israel, 2Assaf Harofeh Medical Center, Pathology, Zeriffin, Israel

Fidenza Hospital, Urology, Parma, Italy

1

Introduction & Objectives: To evaluate the diagnostic efficiency of saturation prostate biopsy in patients with PSA>10ng/ml, free PSA ratio<0.2 and at least 3 sets of negative biopsies (average 3.4 previous biopsy sets per patient, range 3-5). Material & Methods: Twenty three patients underwent saturation prostate biopsies using a transrectal approach under general or regional anesthesia. A systematic coverage of the peripheral zone was accomplished by maintaining a fixed distance between punctures (5mm.). Additionally, multiple cores were obtained from the transition zone bilaterally, bladder neck and midline according to a strict pre-planning. Results: The mean number of cores obtained per patient was 61 (range 4875). Average PSA was 21ng/ml. (range 10.1-49). CAP (Gleason’s 3+3) was found in 3 patients (15%). CAP was established in only one core sampled from the peripheral zone in each case, occupying less than 1% of the core volume. Cancer was not diagnosed in the adjacent 8 cores taken 5mm away. Two patients were designated for watchful waiting and one patient chose radical retropubic prostatectomy. His pathological specimen contained CAP (Gleason 3+3) in less than 1% of the total prostate volume. In one case we found HGPIN that was diagnosed previously. All patients were discharged within 24h following the procedure. Asymptomatic bacteremia was documented in one patient. Eventually, this patient underwent TURP one year later. Pathology was BPH. Two patients developed epididymitis and were treated conservatively.

Introduction & Objectives: The aim of our study is to compare different methods of PSA kinetic such as PSA slope and PSA velocity in men who underwent repeated prostate biopsy. Material & Methods: This study was conducted on 338 male patients evaluated with transrectal ultrasound-guided biopsy of prostate with 6 or more cores. Patients with at least 3 consecutive PSA measurements in at least 18 months entered the study. PSA slope was estimated by the slope of the least squares regression line fit to PSA versus time in years; PSA velocity was calculated as the running average of the rate of change during at least 3 consecutive assays. Results: Median age was 66 years (range 45 to 86). Overall 67 patients were affected by primary prostate cancer, 245 were controls without prostate cancer. PSA slope and PSA velocity were significantly higher in patients with prostate cancer than in controls. At the ROC analysis PSA slope evidenced better results than PSA velocity (AUC 0.743 for PSA slope; AUC 0.663 for PSA velocity; p = 0.037). At PSA slope (calculated with the least square fit) equal to zero, the sensitivity resulted as being 94% with a specificity of 38.8%. Conclusions: PSA slope calculated with 3 or more PSA assays has got better specificity than PSA velocity in men who undergo repeated prostate biopsy for suspected prostate cancer.

Conclusions: In patients with previous multiple negative biopsies, the diagnostic rate of saturation biopsy is low (15%) and does not seem to represent a clear cut biologically significant disease.



395



Complication rates of 7074 transrectal, ultrasound (TRUS) guided biopsies of the prostate: results from the tyrol psa screening project

Repeat prostate biopsy: comparison of cancer detection between the 24 core saturation biopsy scheme and 2 different 12 core schemes

Horninger W.1, Pelzer A.E.1, Bektic J.1, Achleitner R.1, Frauscher F.2, Pallwein L.2, Schäfer G.3, Klocker H.1, Bartsch G.1

Gallé G., Augustin H., Auprich M., Gutschi S., Pummer K., Petritsch P.

Medical University Innsbruck, Dept. of Urology, Innsbruck, Austria, 2Medical University Innsbruck, Dept. of Radiology, Innsbruck, Austria, 3Medical University Innsbruck, Dept. of Pathology, Innsbruck, Austria 1

Introduction & Objectives: To evaluate the complication rates of TRUS guided prostate biopsies in a healthy screening population. Material & Methods: Between January 1993 and October 1995 sextant biopsies, between November 1995 and February 2000 10 systematic biopsies and since then 5 additional targeted biopsies of the prostate were performed. All screening volunteers received oral proplylactic antibiotic therapy (ciprofloxacin 250 mg twice daily) starting one day before the procedure. Complications were categorized in minor complications (haematuria >1 day, hematospermia, rectal bleeding <2 days) and major complications (prostatitis, epididymitits, fever > 38°C, rectal bleeding >2 days and/or requiring surgical intervention, urinary retention, other complications requiring hospitalisation). Complication rates were assessed by a physician either in a personal interview or by phone. Results: 7074 biopsies were performed in 5153 men. Haematuria and haemospermia were the most frequent reported side effects occurring in 13.8% and 35.8%, respectively. Further data are shown in the table below: minor complications: haematuria > 1day haemospermia rectal bleeding < 2 days major complications:

13.8% (n=982) 35.8% (n=2537) 2.1% (n=149)

prostatitis epididymitis fever > 38°C, hospitalisation rectal bleeding > 2days and/or requiring surgical intervention urinary retention other complications requiring hospitalisation

0.9% (n=64) 0.7% (n=50) 0.8% (n=56) 0.6% (n=42)

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Medical University of Graz, Urology, Graz, Austria Introduction & Objectives: The transrectal ultrasound-guided biopsy procedure has undergone a number of modifications to increase the cancer detection rate. Nevertheless there are still a number of patients at increased risk for prostate cancer with previously negative biopsies. To identify the ideal number of cores and to evaluate the benefit of a saturation biopsy scheme in a a re-biopsiy setting, we compared the detection rate of a 24 core saturation biopsy scheme with a 12 core laterally directed biopsy scheme as well as with a 10 core laterally directed biopsy and 2 additional transition zone cores (10+2) scheme. Material & Methods: In sedoanalgesia 3 different urologists performed 24 core saturation prostate biopsies in 184 patients. All patients had undergone at least one negative biopsy in the past and their PSA level was ≤ 20 ng/ml. From each prostate lobe, 10 laterally directed cores of the peripheral zone and 2 of the transition zone were acquired. The 12 core laterally directed regime was defined by 6 cores of the peripheral zone of each lobe, the 10+2 core regime was defined by 5 cores of the peripheral zone and 1 core of the transitional zone of each lobe. The measure of comparison between the different schemes was RPR (relative positivity rate), as calculated by the formula, cancer detection rate of saturation scheme/cancer detection rate of 12 core regime as well as saturation scheme/cancer detection rate of 10+2 core regime, respectively. Results: Median age was 61.6 years (41 – 80), mean PSA was 8.7 ng/ml. 130 patients showed a PSA ≤ 10 ng/ml and 54 of 10-20 ng/ml, respectively. Patients had undergone a mean number of repeated biopsies of 3.8 (ranging between 1 and 9 re-biopsies). 24 cores

12 cores

10+2 cores

56 (30.4) 38 (29.2) 18 (33.3)

60 (32.6) 38 (29.2) 22 (40.7)

Cancer detection n (%)

0.2% (n=14) 0.4% (n=29)

Conclusions: Haematuria and haemospermia are frequently reported, however, they cause minimal discomfort and require no additional treatment; major complications requiring hospitalisation were rare. According to these data TRUS-guided prostate biopsy is a safe procedure in a healthy screening population.

PSA ≤ 20 ng/ml PSA ≤10 ng/ml PSA 10-20 ng/ml

64 (34.8) 40 (30.8) 24 (44.4)

Compared to the 12 core and 10+2 biopsy scheme, the saturation biopsy scheme showed a RPR of 1.14 and 1.07, respectively. Meaning that saturation biopsy scheme detected 14% more cancers than the 12 core scheme and 7% more cancers than the 10+2 scheme. Conclusions: In a repeat biopsy population with PSA lower than 20 ng/ml, prostate biopsy schemes with 10 laterally directed peripheral zone and 2 transition zone cores have nearly the same prostate cancer detection rate as the saturation biopsy scheme with 24 cores. Taking more than 12 cores added only a minimal benefit, but demanded more time and effort.

Eur Urol Suppl 2007;6(2):121