Is There a Role for Anterior Zone Sampling As Part of Saturation Trans-rectal Ultrasound Guided Prostate Biopsy?

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2014 Jun 3

PMID 24884966

Citations 2

Authors

Eric Cole

David Margel

Michael Greenspan

Bobby Shayegan

Edward Matsumoto

Marc A Fischer

Michael Patlas

Dean Daya

Jehonathan H Pinthus

Affiliations

Soon will be listed here.

Abstract

Background: The prostatic anterior zone (AZ) is not targeted routinely by TRUS guided prostate biopsy (TRUS-Pbx). MRI is an accurate diagnostic tool for AZ tumors, but is often unavailable due to cost or system restrictions. We examined the diagnostic yield of office based AZ TRUS-Pbx.

Methods: 127 men at risk for AZ tumors were studied: Patients with elevated PSA and previous extended negative TRUS-Pbx (group 1, n = 78) and actively surveyed low risk prostate cancer patients (group 2, n = 49). None of the participants had a previous AZ biopsy. Biopsy template included suspicious ultrasonic areas, 16 peripheral zone (PZ), 4 transitional zone (TZ) and 6 AZ cores. All biopsies were performed by a single urologist under local peri-prostatic anaesthetic, using the B-K Medical US System, an end-firing probe 4-12 MHZ and 18 ga/25 cm needle. All samples were reviewed by a single specialized uro-pathologist. Multivariate analysis was used to detect predictors for AZ tumors accounting for age, PSA, PSA density, prostate volume, BMI, and number of previous biopsies.

Results: Median PSA was 10.4 (group 1) and 7.3 (group 2). Age (63.9, 64.5), number of previous biopsies (1.5) and cores (17.8, 21.3) and prostate volume (56.4 cc, 51 cc) were similar for both groups. The overall diagnostic yield was 34.6% (group 1) and 85.7% (group 2). AZ cancers were detected in 21.8% (group 1) and 34.7% (group 2) but were rarely the only zone involved (1.3% and 4.1% respectively). Gleason ≥ 7 AZ cancers were often accompanied by equal grade PZ tumors. In multivariate analysis only prostate volume predicted for AZ tumors. Patients detected with AZ tumors had significantly smaller prostates (36.9 cc vs. 61.1 cc p < 0.001). Suspicious AZ ultrasonic findings were uncommon (6.3%).

Conclusions: TRUS-Pbx AZ sampling rarely improves the diagnostic yield of extended PZ sampling in patients with elevated PSA and previous negative biopsies. In low risk prostate cancer patients who are followed by active surveillance, AZ sampling changes risk stratification in 6% but larger studies are needed to define the role of AZ sampling in this population and its correlation with prostatectomy final pathological specimens.

Citing Articles

Clinicopathologic characteristics of anterior prostate cancer (APC), including correlation with previous biopsy pathology.

Magers M, Zhan T, Udager A, Wei J, Tomlins S, Wu A Med Oncol. 2015; 32(11):249.

PMID: 26442515 DOI: 10.1007/s12032-015-0693-9.

Ratio of prostate specific antigen to the outer gland volume of prostrate as a predictor for prostate cancer.

Zhang H, Yan Y, Wang F, Gu W, Hu G, Zheng J Int J Clin Exp Pathol. 2014; 7(9):6079-84.

PMID: 25337254 PMC: 4203225.

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