Is systematic biopsy of the transition zone a necessary supplement to sextant biopsy of the prostate?

Introduction: The aim of this study was to evaluate the diagnostic value of performing 4 additional transition zone biopsies in patients undergoing ro utine sextant biopsy of the prostate. Patients and methods: A total of 324 patients with a serum prostate specifi c antigen (PSA) elevation > 4 ng/ml (n = 287) and/or a suspicious digital r ectal examination (n = 127) were evaluated prospectively. Of the 324,170 pa tients had already undergone one or more previous sets of negative prostati c biopsies. In all patients, 4 transition zone biopsies were taken in addit ion to a routine, ultrasound-guided sextant biopsy. Results: Prostate cancer was found in 110 of the 324 patients. Positive bio psies were located in the transition zones of only 10 of these 110 patients , in the peripheral zones in 32 and 68 patients showed cancer in both perip heral and transition zone biopsy cores. Prostate cancers seen exclusively i n the transition zones were predominantly non-palpable pT1c tumours (7/10) with PSA values between 4 and 10 ng/ml. Compared to patients without previo us biopsies, in those patients with previously negative prostate biopsies t he tumour detection rate of this 10-core-biopsy technique was similar both for overall tumour detection (32,9 % vs 35,1 %) as well as for the detectio n of prostate cancers found exclusively in the transition zones (2,4 % vs 3 ,9 %). Conclusions: Taking four additional transition zone biospies with a routine sextant prostate biopsy only marginally increases the overall tumour detec tion rate. It does, however, lead to the detection of a small number of pro state cancers confined to the transition zone, which present with PSA-eleva tion and negative digital rectal findings.