Update on transrectal ultrasound-guided needle biopsy of the prostate

Over the past decade, the sextant biopsy technique has emerged as the stand ard of care in the detection of prostate cancer. This technique is easy to learn and well tolerated by patients and has a major complication rate of < 1%, However, limitations in cancer detection have been appreciated, particu larly a false-negative rate approaching 25%, This high failure rate has led investigators to refine biopsy techniques to improve cancer detection. Int uitively, increasing the total number off cores should improve cancer detec tion. However, the optimal core number has yet to be defined. Confounding f actors include variability of prostate size, tumor volume, and tumor locati on. Currently, a new standard is emerging prescribing a minimum of eight co res, of which at least three are directed at the lateral aspect of the peri pheral zone. These additional biopsies appear to enhance cancer detection b y about 15%, The improved yield is most pronounced among patients with a se rum prostate specific antigen concentration between 4 and 10 ng/mL and larg er gland volume (>50 cc). These additional biopsies may decrease the need f or repeat biopsies, In the meantime, strategies are being developed for the optimal technique of repeat biopsies among patients with persistent clinic al suspicion in the setting of a prior negative biopsy. Currently, recommen dations include increasing the biopsy number to a minimum of 10 cores, incl uding sampling of the lateral peripheral and transition zones.