Optimizing Performance and Interpretation of Prostate Biopsy: A Critical Analysis of the Literature
The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate. Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy. A co...
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| Published in | European urology Vol. 58; no. 6; pp. 851 - 864 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kidlington
Elsevier B.V
01.12.2010
Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0302-2838 1873-7560 1873-7560 |
| DOI | 10.1016/j.eururo.2010.08.041 |
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| Abstract | The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate.
Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy.
A comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS), nomogram, and diagnosis. Results were restricted to the English language, with preference given to those published within the last 3 yr.
At initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14–18 cores in glands ≥50cm3. Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3–6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound–guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative.
The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper.
The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper. |
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| AbstractList | Abstract Context The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate. Objective Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy. Evidence acquisition A comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS) , nomogram, and diagnosis . Results were restricted to the English language, with preference given to those published within the last 3 yr. Evidence synthesis At initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14–18 cores in glands ≥50 cm3 . Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3–6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound–guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative. Conclusions The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper. The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate. Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy. A comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS), nomogram, and diagnosis. Results were restricted to the English language, with preference given to those published within the last 3 yr. At initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14-18 cores in glands ≥ 50 cm³. Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥ 20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3-6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound-guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative. The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper. The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate.CONTEXTThe number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate.Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy.OBJECTIVEOur aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy.A comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS), nomogram, and diagnosis. Results were restricted to the English language, with preference given to those published within the last 3 yr.EVIDENCE ACQUISITIONA comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS), nomogram, and diagnosis. Results were restricted to the English language, with preference given to those published within the last 3 yr.At initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14-18 cores in glands ≥ 50 cm³. Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥ 20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3-6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound-guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative.EVIDENCE SYNTHESISAt initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14-18 cores in glands ≥ 50 cm³. Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥ 20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3-6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound-guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative.The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper.CONCLUSIONSThe optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper. The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate. Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy. A comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS), nomogram, and diagnosis. Results were restricted to the English language, with preference given to those published within the last 3 yr. At initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14–18 cores in glands ≥50cm3. Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3–6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound–guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative. The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper. The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper. |
| Author | Schröder, Fritz H. Ficarra, Vincenzo Montironi, Rodolfo Chun, Felix K.-H. Epstein, Jonathan I. Scattoni, Vincenzo Montorsi, Francesco Shariat, Shahrokh F. Freedland, Stephen J. |
| Author_xml | – sequence: 1 givenname: Felix K.-H. surname: Chun fullname: Chun, Felix K.-H. email: chun@uke.uni-hamburg.de organization: Department of Urology, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany – sequence: 2 givenname: Jonathan I. surname: Epstein fullname: Epstein, Jonathan I. organization: Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA – sequence: 3 givenname: Vincenzo surname: Ficarra fullname: Ficarra, Vincenzo organization: Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Monoblocco Ospedaliero, Padua, Italy – sequence: 4 givenname: Stephen J. surname: Freedland fullname: Freedland, Stephen J. organization: Section of Surgery, Durham VA Medical Center and Division of Urologic Surgery, Departments of Surgery and Pathology and Duke Prostate Center, Duke University School of Medicine, Durham, NC, USA – sequence: 5 givenname: Rodolfo surname: Montironi fullname: Montironi, Rodolfo organization: Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy – sequence: 6 givenname: Francesco surname: Montorsi fullname: Montorsi, Francesco organization: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy – sequence: 7 givenname: Shahrokh F. surname: Shariat fullname: Shariat, Shahrokh F. organization: Division of Urology (Department of Surgery), Memorial Sloan-Kettering Cancer Center, New York, NY, USA – sequence: 8 givenname: Fritz H. surname: Schröder fullname: Schröder, Fritz H. organization: Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands – sequence: 9 givenname: Vincenzo surname: Scattoni fullname: Scattoni, Vincenzo organization: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy |
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| Copyright | 2010 European Association of Urology European Association of Urology 2015 INIST-CNRS Copyright © 2010 European Association of Urology. All rights reserved. |
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| Keywords | Optimal sampling Review Prostate biopsy Prostate cancer detection Performance evaluation Nephrology Urinary system disease Prostate disease Malignant tumor Interpretation Urology Anatomic pathology Biopsy Diagnosis Performance Urogenital system Male genital diseases Prostate cancer Prostate Bibliographic review Cancer |
| Language | English |
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| Snippet | The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate.
Our... Abstract Context The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of... The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing... |
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| Title | Optimizing Performance and Interpretation of Prostate Biopsy: A Critical Analysis of the Literature |
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