The value of a single biopsy with 12 transperineal cores for detecting prostate cancer in patients with elevated prostate specific antigen

Purpose: Prostate cancer detection on standard sextant biopsy is considered inadequate. Various biopsy protocols have been introduced to improve cance r diagnosis. We report our experience with transperineal 12-core prostate b iopsy. Materials and Methods: In a prospective study 650 patients underwent prosta te specific antigen (PSA) measurement during a 15-month period, of whom 141 with PSA greater than 4 ng./ml. also underwent transperineal 12-core prost ate biopsy using the fan technique. Median PSA was 8 ng./ml. (range 4.1 to 5,000). Results: Prostate cancer was detected in 72 of the 141 patients (51%), incl uding 44 of the 97 (45%) with PSA between 4.1 and 10 ng./ml. This incidence is higher than previously reported in the literature using other biopsy te chniques. Disease was low grade Gleason 2 to 4 in 4 cases (5%), intermediat e grade Gleason 5 to 6 in 26 (35%) and high grade Gleason 7 to 10 in the re maining 42 (60%). Conclusions: A high cancer detection rate is achieved by 12-core transperin eal prostate biopsy. Most tumors represent clinically significant cancer. F urther randomized trials are required to confirm these data.