Evaluation of Multiple Transrectal Ultrasound Guided Biopsies of the Prostate for the Detection of Prostate Cancer

Abstract

Limitations in cancer detection using the sextant biopsy technique have led a number of investigators to reassess this technique and has recently resulted I in great efforts 1 to improve the protocol. The optimum biopsy regimen is st undefined. So We designed this study to evaluate and identify the transrectal ultrasound guided prostate biopsy regimen optimal for prostate cancer detection. Patients and methods: A total of 80 consecutive men undergoing prostate biopsy either because of an elevated PSA > 4ng /ml and /or abnormal digital rectal examination suspicious 'for prostate cancer, were enrolled in the study. Informed written consent w 's obtained for every patient prior to performing the study. Multiple transrectal ultrasound guided biopsies ( 10 cores) were obtained from the prostate; six from the traditional sextant regions and two cores from each of the far lateral region. The two cores from each region were labeled in a separate container and sent for histopathological examination. Results (LUTS) were the commonest presentation (82.8%) of patients.\62.5% of our patients had an abnormal DRE and 86% had PSA level more than 4ng;ml.. Biopsies performed in the 80 patients yielded 34 patients with prostate cancer 1 giving a positive biopsy rate of 42.5%. The traditional sextant biopsy scheme diag11osed 30 patients (88.2%) out of the 34 patients with prostate cancer. The positive biopsy, yield was 64.7%, 82.4%, 88.2% at the base, mid-gland and the apex, respectively. The lowest detection rate was at the base of the gland. The overall detection rate1 of thsextant scheme was 30 patients from the total of 80 patients enrolled in thstudy (37.5%), while that of the peripheral scheme was 32/80 (40%).Combining thel two 1 schemes together, the overall positive biopsy yield increases to 34/80 (411.5%), Conclusions There is a slight improvement in the detection rate of prost1te CaJ?.Cer using the lateral biopsy regimen (40%) compared with the traditional sdtant technique (37.5%). Biopsies obtained at the apex at the parasagittal plane yield¢d the' highest detection rate (88.2%) among the traditional sextant regimen. So, it should, be included in any biopsy regimen. A sextant biopsy regimen including two bores from the apex in the parasagittal plane plus two cores from each anterior hom 1of the peripheral zone laterally yielded the highest detection rate in our series denohng tl\at this regimen is useful in patients with palpable nodularity or hypoechoic 1Iesioni, n the lateral aspect of the gland.