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The factors affecting the examination of outside of prostate and its incomplete tissues sampling in 12 core guided prostatic biopsies directed to the periphery

Year 2020, Volume: 12 Issue: 3, 176 - 180, 31.12.2020

Abstract

Objectives: During prostate tissue sampling, it is recommended to direct toward the lateral of the prostate as prostate cancer displays more localization toward the periphery of prostate tissue. Insufficient tissue sampling is frequently encountered in lateral biopsies, due to the outside structure of the prostate and the prostatic anatomy. We aimed to determine the factors affecting this failure in systematic prostate biopsies taken accompanied by transrectal ultrasonography (TRUS).
Material and Methods: A total of 2509 patients who underwent systematic 12-core guided TRUS biopsy of the periphery in our clinic were enrolled in the study and scanned retrospectively. Patients were divided into two groups as those with non-prostate tissue identified in pathology specimens (Group 1) and with only prostate tissue in all foci (Group 2). Each of the patients were evaluated for age, prostate volume, prostate-specific antigen (PSA), number of tissue samples taken from the periphery in 12-core guided biopsy, normal or abnormal digital rectal examination (DRE) results, absence or presence of tumor in the pathology.
Results: Of the 2509 patients, 467 (18.61%) were identified to have non-prostate tissue. Mean age was 65.6 years, mean PSA was 14 ng/mL, mean PV was 45.5, 19.7% had suspect digital rectal examination and 25.8% were positive for tumor. Among the groups, statistically significant values were obtained for the effects of age (p=0.220), PSA(p=0.030), prostate volume (0.065), digital rectal examination (DRE) (p=0.09) and identification of non-prostate tissue in pathology result (p=0.052).
Conclusion: The PSA values of those without non-prostate tissue in prostate biopsy taken with systematic 12-core TRUS were higher. Patients with tumor identified (+) were observed to have higher observational rates of no non-prostate tissue compared to patients negative for tumor. Patients with suspect DRE were identified to have higher observational rates of no non-prostate tissue.

References

  • 1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66.
  • 2. Mettlin C, Murphy G: Why is the prostate cancer death rate declining in the United states? Cancer 82: 249-251, 1998.
  • 3. Astraldi A: Diagnosis of cancer of the prostate: Biopsy by rectal route. Urol Cutan Rev, 41: 421, 1937.)
  • 4. Matlaga BR, Eskew LA, McCullough DL: Prostate biopsy: Indications and technique. J Urol. 169: 12-7, 2003.
  • 5. Hodge KK, McNeal JE, Terris MK, et al: Random systematic versus directed ultrasound guided transrectal core biopsies of prostate. J Urol. 142: 71-74, 1989.
  • 6. Epstein JI, Walsh PC, Sauvageot J et al: Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer. J Urol 158: 1886- 90, 1997 .
  • 7. Norberg M, Egevad L, Holmberg L et al: The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 50: 562- 6, 1997.
  • 8. Ravery V, Goldblatt L, Royer B et al: Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol 164: 393-6, 2000.
  • 9. Presti JC, Chang JJ, Bhargava V et al: The optimal systematic biopsy scheme should include 8 rather than 6 biopsies: Results of a prospective clinical trial. J Urol 163: 163-7, 2000.
  • 10. Babaian RJ, Toi A, Kazumi K et al: A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 163:152-7, 2000.
  • 11. van der Kwast TH, Lopes C, Santonja C, et al. Guidelines for processing and reporting of prostatic needle biopsies. J Clin Pathol. 2003;56:336-340.
  • 12. Karam JA, Shulman MJ, Benaim EA. Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy. Prostate Cancer Prostatic Dis. 2004;7:38-40.
  • 13. Lawrentschuk N, Toi A, Lockwood GA, et al. Operator is an independent predictor of detecting prostate cancer at transrectal ultrasound guided prostate biopsy. J Urol. 2009;182:2659-2663.
  • 14. Brössner C, Bayer G, Madersbacher S, Kuber W, Klingler C, Pycha A. Twelve prostate biopsies detect significant cancer volumes (> 0.5 mL). BJU Int. 2000;85:705-7.
  • 15. Guichard G, Larré S, Gallina A, et al. Extended 21-sample needle biopsy protocol for diagnosis of prostate cancer in 1000 consecutive patients. Eur Urol. 2007;52:430- 5.
  • 16. Eskicorapci SY, Baydar DE, Akbal C, et al. An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. Eur Urol. 2004;45:444-8.
  • 17. Benchikh El Fegoun A, El Atat R, Choudat L, El Helou E, Hermieu JF, Dominique S, Hupertan V, Ravery V. The learning curve of transrectal ultrasound guided prostate biopsies: implications for training programs. Urology. 2013 Jan;81(1):12-5. doi: 10.1016/j.urology.2012.06.084.
  • 18. Doluoglu OG, Yuceturk CN, Eroglu M, Ozgur BC, Demirbas A, Karakan T, Bozkurt S, ResorluB.Core Length:An Alternative Method for Increasing Cancer Detection Rate in Patients with Prostate Cancer. Urol J. 2015 Nov 14;12(5):2324-8.
  • 19. Dogan HS, Aytac B, Kordan Y, Gasanov F, Yavascaoglu İ. What is the adequacy of biopsies for prostate sampling? Urol Oncol. 2011 May-Jun;29(3):280-3. doi: 10.1016/j.urolonc.2009.03.014. Epub 2009 May 17.

Perifere yönlendirilmiş 12 odak prostat biyopsi uygulamasında prostat dışı ve yetersiz doku örneklemesine etki eden faktörler

Year 2020, Volume: 12 Issue: 3, 176 - 180, 31.12.2020

Abstract

Amaç: Prostat kanseri prostat dokusunun periferine daha fazla yerleşim gösterdiğinden, doku örneklemelerinde prostatın laterallerine yönlendirilmesi önerilmektedir. Lateral örneklemelerde bazı odaklarda prostat dışı doku ve prostatın anatomisinden dolayı yetersiz doku ile karşılaşılmaktadır. Transrektal ultrasonografi (TRUS) eşliğinde alınan sistematik prostat biyopsilerinde prostat dışı doku saptanmasına etki eden faktörler araştırıldı.
Gereç ve Yöntemler: Retrospektif olarak TRUS eşliğinde 12 odak sistematik prostat biyopsisi alınan 2509 hastanın, patoloji spesmenlerinde prostat dışı doku saptanan (grup 1) ve tüm odakların prostat dokusu olanlar (grup 2) olarak iki gruba ayrıldı. Ayrıca; yaş, prostat volümleri (PV), prostat spesifik antijen (PSA) ,dijital rektal muayene (DRM) (şüpheli olanlar ve normal olanlar) faktörlerinin prostat dışı doku gelmesinin etkileri araştırıldı.
Bulgular: 2509 hastanın 467(%18.61)’sinde prostat dışı doku saptandı, ortalama yaşı 65,6 yıl, ortalama PSA 14 ng/ml, ortalama PV 45.5, %19.7’sinin dijital rektal muayenesi şüpheli, %25,8 sinde prostat kanseri saptandı. Gruplar arasında yaş (p=0.220), PSA (p=0.030), prostat volüm (0.065), dijital rektal muayene (DRM) (p=0.09) ve patoloji sonucunun (p=0.052) prostat dışı doku saptanmasına etkileri istatistiksel anlamlılık değerleri elde edildi.
Sonuç: Sistematik 12 odak TRUS eşliğinde alınan prostat biyopsisinde, prostat dışı doku olmayanlarda PSA değerleri daha yüksektir. Tümör (+) tespit edilen hastaların tümör negatiflere göre prostat dışı doku olmama oranları gözlemsel olarak daha yüksektir. DRM şüpheli olan hastaların prostat dışı doku olmama oranları gözlemsel olarak daha yüksek saptandı.

References

  • 1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66.
  • 2. Mettlin C, Murphy G: Why is the prostate cancer death rate declining in the United states? Cancer 82: 249-251, 1998.
  • 3. Astraldi A: Diagnosis of cancer of the prostate: Biopsy by rectal route. Urol Cutan Rev, 41: 421, 1937.)
  • 4. Matlaga BR, Eskew LA, McCullough DL: Prostate biopsy: Indications and technique. J Urol. 169: 12-7, 2003.
  • 5. Hodge KK, McNeal JE, Terris MK, et al: Random systematic versus directed ultrasound guided transrectal core biopsies of prostate. J Urol. 142: 71-74, 1989.
  • 6. Epstein JI, Walsh PC, Sauvageot J et al: Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer. J Urol 158: 1886- 90, 1997 .
  • 7. Norberg M, Egevad L, Holmberg L et al: The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 50: 562- 6, 1997.
  • 8. Ravery V, Goldblatt L, Royer B et al: Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol 164: 393-6, 2000.
  • 9. Presti JC, Chang JJ, Bhargava V et al: The optimal systematic biopsy scheme should include 8 rather than 6 biopsies: Results of a prospective clinical trial. J Urol 163: 163-7, 2000.
  • 10. Babaian RJ, Toi A, Kazumi K et al: A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 163:152-7, 2000.
  • 11. van der Kwast TH, Lopes C, Santonja C, et al. Guidelines for processing and reporting of prostatic needle biopsies. J Clin Pathol. 2003;56:336-340.
  • 12. Karam JA, Shulman MJ, Benaim EA. Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy. Prostate Cancer Prostatic Dis. 2004;7:38-40.
  • 13. Lawrentschuk N, Toi A, Lockwood GA, et al. Operator is an independent predictor of detecting prostate cancer at transrectal ultrasound guided prostate biopsy. J Urol. 2009;182:2659-2663.
  • 14. Brössner C, Bayer G, Madersbacher S, Kuber W, Klingler C, Pycha A. Twelve prostate biopsies detect significant cancer volumes (> 0.5 mL). BJU Int. 2000;85:705-7.
  • 15. Guichard G, Larré S, Gallina A, et al. Extended 21-sample needle biopsy protocol for diagnosis of prostate cancer in 1000 consecutive patients. Eur Urol. 2007;52:430- 5.
  • 16. Eskicorapci SY, Baydar DE, Akbal C, et al. An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. Eur Urol. 2004;45:444-8.
  • 17. Benchikh El Fegoun A, El Atat R, Choudat L, El Helou E, Hermieu JF, Dominique S, Hupertan V, Ravery V. The learning curve of transrectal ultrasound guided prostate biopsies: implications for training programs. Urology. 2013 Jan;81(1):12-5. doi: 10.1016/j.urology.2012.06.084.
  • 18. Doluoglu OG, Yuceturk CN, Eroglu M, Ozgur BC, Demirbas A, Karakan T, Bozkurt S, ResorluB.Core Length:An Alternative Method for Increasing Cancer Detection Rate in Patients with Prostate Cancer. Urol J. 2015 Nov 14;12(5):2324-8.
  • 19. Dogan HS, Aytac B, Kordan Y, Gasanov F, Yavascaoglu İ. What is the adequacy of biopsies for prostate sampling? Urol Oncol. 2011 May-Jun;29(3):280-3. doi: 10.1016/j.urolonc.2009.03.014. Epub 2009 May 17.
There are 19 citations in total.

Details

Primary Language English
Subjects Urology
Journal Section Research Articles
Authors

Huseyin Kocan 0000-0002-0670-8080

Ilker Yildirim This is me 0000-0002-4245-1163

Sinharib Citgez This is me 0000-0002-3897-2951

Mahmut Toktas This is me 0000-0001-9845-5481

Selahattin Çalışkan 0000-0001-7864-8374

Enver Özdemir 0000-0001-8131-9133

Publication Date December 31, 2020
Published in Issue Year 2020 Volume: 12 Issue: 3

Cite

Vancouver Kocan H, Yildirim I, Citgez S, Toktas M, Çalışkan S, Özdemir E. The factors affecting the examination of outside of prostate and its incomplete tissues sampling in 12 core guided prostatic biopsies directed to the periphery. Endourol Bull. 2020;12(3):176-80.