Outcome of laterally directed sextant biopsies of the prostate in screenedmales aged 50-66 years - Implications for sampling order

Objective: Prostate cancer has its most frequent location in the posterior- lateral part of the gland. The aim of this study was to evaluate the cancer detection rate of six systemic prostate biopsies with mid lobar biopsies t aken far laterally in the prostate. Patients and Methods: A total of 692 patients (aged 50-66 years) enrolled i n a screening study underwent prostate biopsies because of an elevated seru m prostate-specific antigen (PSA; greater than or equal to3 ng/ml) level. T he outcome of the biopsies was related to findings at digital rectal examin ation (DRE) and transrectal ultrasound (TRUS) and to the location within th e prostate. Results: Prostate cancer was detected in 164 patients. DRE and TRUS were su spicious of malignancy in 66 cases (40%) and 84 cases (51%), respectively. The two biopsies taken far laterally midlobar in the prostate detected as m any as 83% of the cancers and when combined with two apical biopsies, 96% o f all cancers were detected. Conclusion: At PSA screening in this age-group, only 57% of the prostate ca ncers detectable by sextant biopsies were palpable or visible at TRUS. Most of the cancers (96%) were detectable by only four systematic, carefully di rected biopsies. In men with normal DRE, the two lateral midlobar biopsies should be taken first during the biopsy procedure. Copyright (C) 2001 S. Ka rger AG, Basel.