INDICATIONS FOR ULTRASOUND-GUIDED TRANSITION ZONE BIOPSIES IN THE DETECTION OF PROSTATE-CANCER

Transrectal prostate ultrasound and systematic sextant biopsies have i mproved peripheral zone cancer diagnosis but they may miss many cancer s arising in the transition zone. Biopsies directed into the transitio n zone have been used to detect residual prostate cancer in patients d iagnosed by transurethral resection and they have been suggested as po tentially useful additions to systematic sextant biopsies. To define t he indications for transition zone biopsies 187 men underwent evaluati on including systematic sextant biopsies and transition zone biopsies. These patients were classified into 4 categories based on clinical pr esentation. Category 1 included 26 men with palpable nodularity and an elevated prostate specific antigen (PSA), of whom 16 (61.5%) had posi tive biopsies but none was positive only in the transition zone biopsi es. Category 2 consisted of 49 men with sonographic abnormalities in t he transition zone, of whom 15 (30.6%) had positive biopsies, includin g 2 (13.3%) with only positive transition zone biopsies. Category 3 co nsisted of 65 men with normal rectal examination and elevated PSA leve l, of whom 24 (36.9%) had biopsies positive for cancer, including 8 (3 3.3%) with only positive transition zone biopsies. Category 4 consiste d of 47 men with a clinical presentation highly suspicious of prostati c malignancy but no cancer on prior systematic sextant biopsies, of wh om 17 (37.7%) had positive biopsies, including 9 (53.0%) with only pos itive transition zone biopsies. We conclude that transition zone biops ies are useful in patients with a high suspicion of prostate cancer an d negative prior systematic sextant biopsies. Cancer can also be demon strated in many men with a normal digital rectal examination and an el evated PSA level. Patients with transition zone abnormalities on ultra sound images or palpable nodularity do not have substantially increase d cancer detection with the addition of transition zone biopsies.