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A randomised trial comparing two protocols for transrectal prostate repeat biopsy : six lateral posterior plus six anterior cores versus a standard posterior 12-core biopsy

Örtegren, Joakim; Holmberg, Jan Tage LU ; Lekås, Edvard; Mana, Sabah; Mårtensson, Stig; Richthoff, Jonas LU ; Sundqvist, Pernilla; Kjölhede, Henrik LU ; Bratt, Ola LU and Liedberg, Fredrik LU (2019) In Scandinavian Journal of Urology
Abstract

Objective: To test the hypothesis that a combination of 6 posterior and 6 anterior cores detects more cancer than 12 posterior cores at a repeat transrectal prostate biopsy in men who have had one previous benign systematic biopsy. Patients and methods: Three hundred and forty men with persistently raised serum PSA were randomly allocated 1:1 to either a standard 12-core biopsy (12 cores from the lateral peripheral zone through a side-fire biopsy canal) or an experimental 12-core biopsy protocol with 6 anterior cores through an end-fire biopsy canal and 6 cores from the lateral peripheral zone through a side-fire biopsy canal. All biopsies were obtained transrectally with ultrasound guidance. The primary endpoint was cancer detection.... (More)

Objective: To test the hypothesis that a combination of 6 posterior and 6 anterior cores detects more cancer than 12 posterior cores at a repeat transrectal prostate biopsy in men who have had one previous benign systematic biopsy. Patients and methods: Three hundred and forty men with persistently raised serum PSA were randomly allocated 1:1 to either a standard 12-core biopsy (12 cores from the lateral peripheral zone through a side-fire biopsy canal) or an experimental 12-core biopsy protocol with 6 anterior cores through an end-fire biopsy canal and 6 cores from the lateral peripheral zone through a side-fire biopsy canal. All biopsies were obtained transrectally with ultrasound guidance. The primary endpoint was cancer detection. Secondary endpoints were detection of ISUP Grade Groups/Gleason Grade Group ≥2 cancer, total biopsy cancer length and complications leading to medical intervention. Results: Prostate cancer was detected in 42/168 men (25%) in the experimental biopsy group and in 36/172 (21%) in the standard biopsy group (p = 0.44). The corresponding proportions for Gleason score ≥7 were 12% and 7% (p = 0.14). Median total cancer length was 4 (inter quartile range [IQR] = 1.5 − 6) mm in the end-fire group and 3 (IQR = 1.3 − 7) mm in the side-fire group. Ten men in the end-fire group and three in the side-fire group had a medical intervention for biopsy-related complications (p = 0.05). Conclusion: The biopsy protocol that included six end-fire anterior cores did not detect more cancer and was associated with more complications.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
anterior biopsies, end-fire, Prostate cancer, randomized, rebiopsy, side-fire
in
Scandinavian Journal of Urology
publisher
Taylor & Francis
external identifiers
  • scopus:85067653091
ISSN
2168-1805
DOI
10.1080/21681805.2019.1628102
language
English
LU publication?
yes
id
6b748751-c21c-4095-8ed9-599a10d6ad7e
date added to LUP
2019-07-08 14:03:39
date last changed
2019-07-30 05:06:24
@article{6b748751-c21c-4095-8ed9-599a10d6ad7e,
  abstract     = {<p>Objective: To test the hypothesis that a combination of 6 posterior and 6 anterior cores detects more cancer than 12 posterior cores at a repeat transrectal prostate biopsy in men who have had one previous benign systematic biopsy. Patients and methods: Three hundred and forty men with persistently raised serum PSA were randomly allocated 1:1 to either a standard 12-core biopsy (12 cores from the lateral peripheral zone through a side-fire biopsy canal) or an experimental 12-core biopsy protocol with 6 anterior cores through an end-fire biopsy canal and 6 cores from the lateral peripheral zone through a side-fire biopsy canal. All biopsies were obtained transrectally with ultrasound guidance. The primary endpoint was cancer detection. Secondary endpoints were detection of ISUP Grade Groups/Gleason Grade Group ≥2 cancer, total biopsy cancer length and complications leading to medical intervention. Results: Prostate cancer was detected in 42/168 men (25%) in the experimental biopsy group and in 36/172 (21%) in the standard biopsy group (p = 0.44). The corresponding proportions for Gleason score ≥7 were 12% and 7% (p = 0.14). Median total cancer length was 4 (inter quartile range [IQR] = 1.5 − 6) mm in the end-fire group and 3 (IQR = 1.3 − 7) mm in the side-fire group. Ten men in the end-fire group and three in the side-fire group had a medical intervention for biopsy-related complications (p = 0.05). Conclusion: The biopsy protocol that included six end-fire anterior cores did not detect more cancer and was associated with more complications.</p>},
  author       = {Örtegren, Joakim and Holmberg, Jan Tage and Lekås, Edvard and Mana, Sabah and Mårtensson, Stig and Richthoff, Jonas and Sundqvist, Pernilla and Kjölhede, Henrik and Bratt, Ola and Liedberg, Fredrik},
  issn         = {2168-1805},
  keyword      = {anterior biopsies,end-fire,Prostate cancer,randomized,rebiopsy,side-fire},
  language     = {eng},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Urology},
  title        = {A randomised trial comparing two protocols for transrectal prostate repeat biopsy : six lateral posterior plus six anterior cores versus a standard posterior 12-core biopsy},
  url          = {http://dx.doi.org/10.1080/21681805.2019.1628102},
  year         = {2019},
}