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

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. 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.

Trial registration: ClinicalTrials.gov identifier: NCT02761135.

Keywords:

• Prostate cancer
• rebiopsy
• end-fire
• side-fire
• randomized
• anterior biopsies

Disclosure statement

Joakim Örtegren, Jan Tage Holmberg, Edvard Lekås, Sabah Mana, Stig Mårtensson, Jonas Richtoff, Pernilla Sundqvist, Henrik Kjölhede, Ola Bratt and Fredrik Liedberg have nothing to declare.

Additional information

Funding

This research was supported by grants from the Swedish Cancer Society (2017/278), FoU Kronoberg and Cancerstiftelsen Kronoberg.