Transrectal ultrasound guided prostate needle biopsy

Accepted standard procedure for the diagnosis of prostate cancer.

Estimated 624,000 procedures done in 2006 in the U.S.

A sextant biopsy has a sensitivity of diagnosing prostate cancer in the range of 59-65%.

Extended sextant biopsy used to randomly sampled the entire organ.

Performing a second sextant biopsy results in approximately 20% increase in the diagnosis of prostate cancer.

A sextant biopsy associated with a false negative in up to 34% of cases.

In a study of patients with an initial negative prostate biopsy and elevated PSA, (a follow-up of 164 men) prostate cancer was detected in only 11% with a 7 year follow-up (Boddy JL et al).

Performing a sextant biopsy with two extra cores per side from lateral areas, i.e. a 10-core biopsy results in a higher detection rate than two sextant biopsies.

Antibiotic prophylaxis with quinolone agents accepted management.

Antibiotic prophylaxis decreases rates of infection.

Enemas before biopsy provide no clinically significant outcome advantage.

Associated with frequent minor (60-79%) and rare major (0.4-4.3%) complications and hospitalization is reported to occur (0.4-3.4%).

Complications include: Biopsy related sepsis, pain, discomfort, urinary retention, hematuria, hematospermia, and rectal bleeding.

When High Grade Prostatic Intraepithelial Neoplasia (HGPIN) is diagnosed on prostate biopsy, in the absence of atypia or actual prostate cancer, follow-up depends on the amount of HGPIN that is seen.

On a biopsy where unifocal changes is seen, suggested repeat PSA and examination testing on a yearly basis and repeat biopsy in three years.

When extensive HGPIN is reported repeat biopsy is suggested at 6 months to a year.

Diagnosis of carcinoma is supported by the failure of immunoperoxidase staining for high molecular weight cytokeratin and P63 to demonstrate basal cells in the atypical glands.

Stains for RACEMASE, a marker preferentially expressed in prostate cancer, suggest the presence of cancer.

Biopsy criteria for selection of men for our Active Surveillance protocol include: No more than two cores positive for cancer, No core with cancer with >50% involvement, and No core with Gleason score >6.

Antibiotic resistant E.coli strains are present in as much as 20% of the men presenting for biopsy.

Multiparametric magnetic resonance imaging (MP-MRI) allows for imaging based identification of prostate cancer which may improve diagnostic accuracy for high-risk tumors.

MP-MRI images superimposed in real time on transrectal ultrasound allows biopsies of suspicious regions of the prostate.

Targeted MR/ultrasound fusion biopsy compared with standard extended sextant ultrasound guided biopsy is associated with increased detection of high risk prostate cancer and decrease detection of low risk prostate cancer (Siddiqui MM et al).

In the above study targeted biopsy increased the detection of a high risk prostate cancer while decreasing the detection of low risk prostate cancer compared with standard biopsy.

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