The Superiority of the 24-Core Transrectal Ultrasound- Guided Biopsy Technique in Prostate Cancer Detection and Characterization

The Superiority of the 24-Core Transrectal Ultrasound- Guided Biopsy Technique in Prostate Cancer Detection and Characterization
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Title:The Superiority of the 24-Core Transrectal Ultrasound- Guided Biopsy Technique in Prostate Cancer Detection and Characterization
Author/Abstract:
Paulo Jesus F. Fernandez, MD*; Jason L. Letran, MD, FPUA** and John Kenneth B. Domingo, MD, FPUA***

Section of Urology, Department of Surgery, University of Santo Tomas Hospital

Objective: This study aimed to compare the prostate cancer detection rates of 12, 18 and 24 core techniques based on the experience of a single operator. It also aimed to compare the ability of the respective biopsy schemes to identify intermediate and high-grade prostate cancer (Gleason > 7). Furthermore, this study intended to determine if increasing number of cores is associated with an increase in major complications.

Materials and Methods: A total of 903 patients were identified. Inclusion criteria included serum prostate specific antigen (PSA) levels from 2.5 to 20 ng/ml or an abnormal digital rectal examination (DRE) regardless of PSA level. The patients were grouped according to the biopsy technique utilized: 12 core (Group A), 18 core (Group B), and 24 cores (Group C). All procedures were performed by a single operator, utilizing the same model of ultrasound machine. The one-way ANOVA was used to establish homogeneity of the population. The differences between the detection rates as well as the ability to characterize intermediate and high-grade tumors were tested using the Cochran's Q-test and McNemar's test with a P value of less than 0.05 being statistically significant.

Results: The 24 core method had a significantly higher detection rate of 36.4%(193/530) as compared to 12 and 18 core technique, which had detection rates of 29.4% (57/194) and 28.3% (51/179) respectively (P = 0.001). A total of 54.4% (105/193) of cancers detected by the 24 core technique were of Gleason 7 or greater. This was significantly greater compared to the 28.1% (16/57) of the 12 core and 31.4% (16/51) of the 18 core technique respectively in detecting Gleason score . 7 (P=0.001).There was no difference in the mean age, PSA levels, prostate volumes and percentage of patients with abnormal DRE. There were 3 cases of infection requiring parenteral antibiotics (one for each group), 2 cases of bleeding requiring transfusion (Groups A and C) and one case of acute urinary retention (Group A).

Conclusion: The 24 core prostate biopsy technique has the highest overall cancer detection ratecompared to the 12 and 18 core methods. Moreover, the 24-core technique detects a greater proportion of intermediate and high-grade cancers. There was no significant increase in the incidence of major complications with increasing number of cores.

Key words: prostate cancer, prostate specific antigen
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