Prostate Biopsy Strategies: Current State of the Art

Prostate-specific antigen testing and prostate biopsy have revolutionized our ability to detect prostate cancer at an early stage. The transrectal ultrasound-guided biopsy procedure has undergone a number of modifications over the past 10 years to meet our goal of early detection of cancer at a curable stage. Biopsy schemes have evolved from lesion-directed biopsies to systematic mapping of the peripheral zone of the prostate, which harbors almost all of the significant tumor foci. An increase in the number of biopsy cores from 6 to 10 (or 12) has resulted in a significant improvement in the detection of clinically localized cancer, without any appreciable increase in the number of indolent cancers. Current biopsy schemes also have enhanced our ability to determine the true prognostic value of pathologic lesions such as high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation which have been associated with cancer detection in repeat biopsies. I discuss the rationale behind, and the outcomes of, various biopsy strategies. More than 15 years after PSA testing was popularized for early detection, a number of men are presenting for evaluation regarding repeat prostate biopsy for various clinical indications. The indications, biopsy scheme, and cancer detection rates for repeat prostate biopsy are discussed in detail.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Correspondence: Badar M. Mian, MD, Assistant Professor of Surgery/Urology, Albany Medical College, Stratton VA Medical Center, 23 Hackett Boulevard, Albany, New York 12208. E-mail: mianb@mail.amc.edu
  • 1

    JemalAMurrayTSamuelsA. Cancer statistics, 2003. CA Cancer J Clin2003;53:526.

  • 2

    HodgeKKMcNealJETerrisMK.: Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol1989;142:7174.

    • Search Google Scholar
    • Export Citation
  • 3

    StameyTA. Making the most out of six systematic sextant biopsies. Urology1995;45:212.

  • 4

    CatalonaWJRichieJPAhmannFR. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol1994;151:12831290.

    • Search Google Scholar
    • Export Citation
  • 5

    ChangJJShinoharaKBhargavaV. Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol1998;160:21112114.

    • Search Google Scholar
    • Export Citation
  • 6

    ReissiglAPointnerJStrasserH. Frequency and clinical significance of transition zone cancer in prostate cancer screening. Prostate1997;30:130135.

    • Search Google Scholar
    • Export Citation
  • 7

    BazinetMKarakiewiczPIAprikianAG. Value of systematic transition zone biopsies in the early detection of prostate cancer. J Urol1996;155:605606.

    • Search Google Scholar
    • Export Citation
  • 8

    OnderAUYalcinVArarO. Impact of transition zone biopsies in detection and evaluation of prostate cancer. Eur Urol1998;33:542548.

  • 9

    FowlerJEJrBiglerSAKilambiNK. Results of transition zone biopsy in black and white men with suspected prostate cancer. Urology1999;53:346350.

    • Search Google Scholar
    • Export Citation
  • 10

    MaedaHIshitoyaSAokiY.: Value of systematic transition zone biopsy in the detection of prostate cancer. Int J Urol1997;4:567571.

  • 11

    LuiPDTerrisMKMcNealJE. Indications for ultrasound guided transition zone biopsies in the detection of prostate cancer. J Urol1995;153:10001003.

    • Search Google Scholar
    • Export Citation
  • 12

    LiuIJMacyMLaiY. Critical evaluation of the current indications for transition zone biopsies. Urology2001;57:11171120.

  • 13

    KeetchDWCatalonaWJSmithDS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol1994;151:15711574.

    • Search Google Scholar
    • Export Citation
  • 14

    RoehrbornCGPickensGJSandersJS. Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology1996;47:347352.

    • Search Google Scholar
    • Export Citation
  • 15

    FleshnerNEO'SullivanMFairWR. Prevalence and predictors of a positive repeat transrectal ultrasound guided needle biopsy of the prostate. J Urol1997;158:505508.

    • Search Google Scholar
    • Export Citation
  • 16

    LevineMAIttmanMMelamedJ. Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol1998;159:471475.

    • Search Google Scholar
    • Export Citation
  • 17

    EskewLABareRLMcCulloughDL. Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol1997;157:199202.

    • Search Google Scholar
    • Export Citation
  • 18

    BabaianRJToiAKamoiK. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol2000;163:152157.

    • Search Google Scholar
    • Export Citation
  • 19

    ChenMETroncosoPJohnstonDA. Optimization of prostate biopsy strategy using computer based analysis. J Urol1997;158:21682175.

  • 20

    PrestiJCJrChangJJBhargavaV. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol2000;163:163166.

    • Search Google Scholar
    • Export Citation
  • 21

    GoreJLShariatSFMilesBJ. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol2001;165:15541559.

    • Search Google Scholar
    • Export Citation
  • 22

    ChanTYChanDYStutzmanKL. Does increased needle biopsy sampling of the prostate detect a higher number of potentially insignificant tumors?J Urol2001;166:21812184.

    • Search Google Scholar
    • Export Citation
  • 23

    TaylorJA3rdGancarczykKJFantGV. Increasing the number of core samples taken at prostate needle biopsy enhances the detection of clinically significant prostate cancer. Urology2002;60:841845.

    • Search Google Scholar
    • Export Citation
  • 24

    FinkKGHutarewGPytelA. One 10-core prostate biopsy is superior to two sets of sextant prostate biopsies. BJU Int2003;92:385388.

  • 25

    MianBMNayaYOkiharaK. Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy. Urology2002;60:836840.

    • Search Google Scholar
    • Export Citation
  • 26

    MooreMLehrDNazeerT. Significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. (submitted for publication)

    • Export Citation
  • 27

    HausslerOEpsteinJIAminMB. Cell proliferation, apoptosis, oncogene, and tumor suppressor gene status in adenosis with comparison to benign prostatic hyperplasia, prostatic intraepithelial neoplasia, and cancer. Hum Pathol1999;30:10771086.

    • Search Google Scholar
    • Export Citation
  • 28

    BostwickDG. Prostatic intraepithelial neoplasia is a risk factor for cancer. Semin Urol Oncol1999;17:187198.

  • 29

    GreenbergNMDeMayoFFinegoldMJ. Prostate cancer in a transgenic mouse. Proc Natl Acad Sci USA1995;92:34393443.

  • 30

    XieWWongYCTsaoSW. Correlation of increased apoptosis and proliferation with development of prostatic intraepithelial neoplasia (PIN) in ventral prostate of the Noble rat. Prostate2000;44:3139.

    • Search Google Scholar
    • Export Citation
  • 31

    PrangeWErbersdoblerAHammererP. High-grade prostatic intraepithelial neoplasia in cystoprostatectomy specimens. Eur Urol2001;39(suppl 4):3031.

    • Search Google Scholar
    • Export Citation
  • 32

    OyasuRBahnsonRRNowelsK. Cytological atypia in the prostate gland: frequency, distribution and possible relevance to carcinoma. J Urol1986;135:959962.

    • Search Google Scholar
    • Export Citation
  • 33

    McNealJEBostwickDG. Intraductal dysplasia: a premalignant lesion of the prostate. Hum Pathol1986;17:6471.

  • 34

    HoedemaekerRFKranseRRietbergenJB. Evaluation of prostate needle biopsies in a population-based screening study: the impact of borderline lesions. Cancer1999;85:145152.

    • Search Google Scholar
    • Export Citation
  • 35

    OrozcoRO'DowdGKunnelB. Observations on pathology trends in 62,537 prostate biopsies obtained from urology private practices in the United States. Urology1998;51:186195; erratum: 1998;51:523.

    • Search Google Scholar
    • Export Citation
  • 36

    WeinsteinMHEpsteinJI. Significance of high-grade prostatic intraepithelial neoplasia on needle biopsy. Hum Pathol1993;24:624629.

  • 37

    DavidsonDBostwickDGQianJ. Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies. J Urol1995;154:12951299.

    • Search Google Scholar
    • Export Citation
  • 38

    AboseifSShinoharaKWeidnerN. The significance of prostatic intra-epithelial neoplasia. Br J Urol1995;76:355359.

  • 39

    O'DowdGJMillerMCOrozcoR. Analysis of repeated biopsy results within 1 year after a noncancer diagnosis. Urology2000;55:553559.

  • 40

    KronzJDAllanCHShaikhAA. Predicting cancer following a diagnosis of high-grade prostatic intraepithelial neoplasia on needle biopsy: data on men with more than one follow-up biopsy. Am J Surg Pathol2001;25:10791085.

    • Search Google Scholar
    • Export Citation
  • 41

    LefkowitzGKSidhuGSTorreP. Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?Urology2001;58:9991003.

    • Search Google Scholar
    • Export Citation
  • 42

    LefkowitzGKTanejaSSBrownJ. Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J Urol2002;168:14151418.

    • Search Google Scholar
    • Export Citation
  • 43

    IczkowskiKAMacLennanGTBostwickDG. Atypical small acinar proliferation suspicious for malignancy in prostate needle biopsies: clinical significance in 33 cases. Am J Surg Pathol1997;21:14891495.

    • Search Google Scholar
    • Export Citation
  • 44

    ParkSShinoharaKGrossfeldGD. Prostate cancer detection in men with prior high grade prostatic intraepithelial neoplasia or atypical prostate biopsy. J Urol2001;165:14091414.

    • Search Google Scholar
    • Export Citation
  • 45

    RenshawAASantisWFRichieJP. Clinicopathological characteristics of prostatic adenocarcinoma in men with atypical prostate needle biopsies. J Urol1998;159:20182021.

    • Search Google Scholar
    • Export Citation
  • 46

    IczkowskiKAChenHMYangXJ. Prostate cancer diagnosed after initial biopsy with atypical small acinar proliferation suspicious for malignancy is similar to cancer found on initial biopsy. Urology2002;60:851854.

    • Search Google Scholar
    • Export Citation
  • 47

    AllenEAKahaneHEpsteinJI. Repeat biopsy strategies for men with atypical diagnoses on initial prostate needle biopsy. Urology1998;52:803807.

    • Search Google Scholar
    • Export Citation
  • 48

    StewartCSLeibovichBCWeaverAL. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol2001;166:8691.

    • Search Google Scholar
    • Export Citation
  • 49

    BorborogluPGComerSWRiffenburghRH. Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol2000;163:158162.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 75 66 2
PDF Downloads 28 23 0
EPUB Downloads 0 0 0