Prostate cancer diagnosis using a saturation needle biopsy technique afterprevious negative sextant biopsies

Purpose: We hypothesized that markedly increasing the number of cores obtai ned during prostate needle biopsy may improve the cancer detection rate in men with persistent indications for repeat biopsy. Materials and Methods: We performed saturation ultrasound guided transrecta l prostate needle biopsy in 224 men under anesthesia in an outpatient surgi cal setting in whom previous negative biopsies had been performed in the of fice. The mean number of previous sextant biopsy sessions plus or minus sta ndard deviation before saturation biopsy was 1.8 (range 1 to 7). A mean of 23 saturation biopsy cores (range 14 to 45) were distributed throughout the whole prostate, including the peripheral, medial and anterior regions. ind ications for repeat biopsy were persistent elevated serum prostate specific antigen (PSA) in 108 cases, persistent elevated PSA and abnormal rectal ex amination in 27, persistent abnormal rectal examination in 4, high grade pr ostatic intraepithelial neoplasia in the previous biopsy in 64 and atypia i n the previous biopsy in 21. Results: Cancer was detected in 77 of 224 patients (34%). The number of pre vious negative sextant biopsies was not predictive of subsequent cancer det ection by saturation biopsy. Median PSA was 8.7 ng./ml. and median PSA velo city was 0.63 ng./ml, yearly. Of the 77 patients in whom cancer was detecte d radical prostatectomy was performed in 52. Pathological stage was pT2 in 48 patients and pT3 in 4, while Gleason score was 4 to 5, 6 to 7 and 8 in 5 , 46 and 1, respectively. At prostatectomy median cancer volume was 1.04 cc and 85.7% of removed tumors were clinically significant, assuming a 3-year doubling time. The overall complication rate for saturation needle biopsy was 12% and hematuria requiring hospital admission was the most common even t. Conclusions: Saturation needle biopsy of the prostate is a useful diagnosti c technique in men at risk for prostate cancer with previous negative offic e biopsies. This technique allows adequate sampling of the whole prostate g land and has a detection rate of 34% in this cohort of patients.