Lateral biopsies added to the traditional sextant prostate biopsy pattern increases the detection rate of prostate cancer

Urologists routinely use the systematic sextant needle biopsy technique to detect prostate cancer. However, recent evidence suggests that this techniq ue has a significant sampling error and data based upon whole-mounted step- sectioned radical, prostatectomy specimens using a three-dimensional comput er-assisted prostate biopsy simulator suggests that an increased detection rate is possible using laterally placed biopsies. The simulated 10-core bio psy pattern (traditional sextant biopsy cores and four laterally placed bio psies in the right and left apex and mid portion of the prostate gland) was shown to be superior to the traditional sextant biopsy. The objective of t his pilot study was to confirm the higher prostate cancer detection rate ob tained using the 10-core biopsy pattern in patients. We reviewed data on 35 consecutive patients with a pathologic diagnosis of prostate cancer biopsi ed by a single urologist using the 10-core biopsy pattern. The frequency of positive biopsy was determined for each core. Additionally, the sextant an d 10-core prostate biopsy patterns were compared with respect to prostate c ancer detection rate. Of the 35 patients diagnosed with prostate cancer, 54 .3%(19/35) were diagnosed by the sextant biopsy only. The 10-core pattern r esulted in an additional 45.7%(16/35) of patients being diagnosed solely wi th the laterally placed biopsies. The laterally placed biopsies had the hig hest frequency of positive biopsies when compared to the sextant cores. In conclusion, biopsy protocols that use laterally placed biopsies based upon a five region anatomical model are superior to the routinely used sextant p rostate biopsy pattern.