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19 August 2019 : Clinical Research  

The Specific Choice of Transrectal Ultrasound-Guided Prostate Biopsy Scheme Based on Prostate Specific Antigen and Prostate Specific Antigen Density

Yue Chen1BCEFG, Xingkang Jiang1BCE, Ranlu Liu1CE, Zhihong Zhang1AE, Fei Luo2CE, Shiyong Qi1ADEG*, Yong Xu1ADEG

DOI: 10.12659/MSM.915826

Med Sci Monit 2019; 25:6230-6235

Abstract

BACKGROUND: Although magnetic resonance imaging (MRI)-targeted biopsy and saturation biopsy can improve the accuracy of prostate biopsy, transrectal ultrasound (TRUS)-guided prostate biopsy is still the cornerstone for diagnosis of prostate cancer. However, it is not clear whether it is necessary to perform the same TRUS-guided biopsy scheme for patients with different prostate specific antigen (PSA) or prostate specific antigen density (PSAD) levels. The purpose of this study was to evaluate the optimal core number for specific suspected prostate cancer patients.

MATERIAL AND METHODS: There were 398 patients who underwent 12-core biopsy scheme, who were included in this retrospective analysis. The 12-core scheme incorporated a classic sextant scheme and 4-core biopsies from the base and middle regions bilaterally. The cancer detection rates of patients with different PSA or PSAD levels between the 12-core, sextant, 4-core, and 2-core biopsy were compared.

RESULTS: The differences in cancer detection rates between the 12-core biopsy scheme and the sextant biopsy scheme were significant in patients with PSA <20 ng/mL or PSAD <0.3. There were no differences in the cancer detection rates between the 12-core biopsy scheme and the 4-core biopsy scheme in patients with PSA ≤50 ng/mL or PSAD ≤1.0. There were significant differences between 12-core and 2-core scheme when PSA ≤70 ng/mL or PSAD ≤1.5.

CONCLUSIONS: We recommend that the 12-core biopsy should be used for patients with PSA <20 ng/mL or PSAD <0.3. The biopsy scheme in patients with PSA 20–50 ng/mL or PSAD 0.3–1.0 should be considered in combination with DRE and MRI. For patients with PSA >50 ng/mL or PSAD >1.0, we recommend 6-core or 4-core biopsy by comprehensively considering multiple factors. The 2-core biopsy is recommended for patients with PSA >70 ng/mL or PSAD >1.5.

Keywords: Biopsy, Prostate-Specific Antigen, Ultrasound, High-Intensity Focused, Transrectal, Aged, 80 and over, Biopsy, Large-Core Needle, Kallikreins, Microscopy, Acoustic, Prostate, Prostatic Neoplasms, Ultrasonography

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750