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Abstract
Objective: To evaluate the importance of extended 11-core biopsy in benign prostatic hyperplasia (BPH) patients with intermediate prostate-specific antigen (PSA; 4.1–10 ng/ml) and prior negative sextant biopsy.
Material and Methods: A total of 381 BPH patients with intermediate PSA (4.1–10 ng/ml) and prior negative sextant biopsy underwent extended 11-core biopsy, which included conventional sextant biopsy in addition to five cores from three alternative sites. Two cores were taken from the right and left anterior horns of the peripheral zone (PZ), two from the right and left anterior transition zones (TZs) and one from the midline of the PZ. Overall, 315 patients were subjected to transurethral resection of the prostate (n=272) or open prostatectomy (n=43).
Results: Repeat 11-core biopsy revealed prostate cancer in 66/381 cases (17.3%). The distribution of positive cores on repeat 11-core biopsy was as follows: sextant biopsy sites only in 50% of cases (33/66); alternative sites only in 31.8% (21/66); and sextant plus alternative biopsy sites in 18.2% (12/66). The anterior horn of the PZ was the most frequently positive alternative site (25/33; 75.8%), followed by the TZ (5/33; 15.2%), while the midline site was involved in 9% of cases (3/33). Eleven-core biopsy had a significantly better cancer detection rate compared to sextant biopsy when digital rectal examination was normal (p=0.009), prostate volume was in the range 30–50 cm3 (p=0.033) and PSA density was ≥0.15 (p=0.024). Six cancer cases out of 315 (1.9%) were diagnosed as a result of the definitive pathology. The sensitivity of 11-core biopsy was 91.6%, compared to 62.5% for sextant biopsy (p < 0.001).
Conclusion: An extended 11-core biopsy protocol is valuable in BPH patients with intermediate PSA (4.1–10 ng/ml) and prior negative sextant biopsy as it significantly improved the overall detection rate in our study by 32% (p=0.019).