Are transition zone biopsies still necessary to improve prostate cancer detection? Results from the tyrol screening project

• Published in: European urology Vol. 48; no. 6; pp. 916 - 21; discussion 921
• Main Authors: Pelzer, Alexandre E, Bektic, Jasmin, Berger, Andreas P, Halpern, Ethan J, Koppelstätter, Florian, Klauser, Andrea, Rehder, Peter, Horninger, Wolfgang, Bartsch, Georg, Frauscher, Ferdinand
• Format: Journal Article
• Language: English
• Published: Switzerland 01.12.2005
• Subjects: Adult; Aged; Austria; Biomarkers, Tumor - blood; Biopsy, Needle - methods; Contrast Media; Endosonography - methods; Humans; Male; Mass Screening - methods; Middle Aged; Neoplasm Staging; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - prevention & control; Radiographic Image Enhancement; Retrospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2005.07.012

The present retrospective study was designed to investigate the value of transition zone (TZ) biopsies for prostate cancer (PC) detection rate in a combined contrast enhanced color Doppler targeted (CECD) and gray-scale systematic biopsy (SB) approach. PSA screening participants totalling 1475 with tPSA of >1.25 ng/ml (fPSA< or =18%) were assessed. Ten SB and additionally 5 or fewer CECD were performed. The impact of TZ biopsies on the PC detection rate and the biological significance of the detected TZ-cancers were analyzed. Out of 1475 biopsied patients, 395 (26.8%) were identified as PC patients; 5925 biopsy cores from these patients were analyzed. In 86 patients (21.8% of PC), we found 102 PC- positive cores in the TZ, and only in 9 of them solitary TZ-cancers without any other PC-location (2.3% of PC or 0.6% of all investigated patients). Pathologic findings after retropubic prostatectomy (RPE) revealed multifocal adenocarcinoma including involved peripheral zone (PZ) in eight of these nine patients, and solitary TZ-cancer in one patient. There was no positive correlation between prostate volume and TZ-detection rate and no patient with solitary TZ-PC after rebiopsy. Biopsy revealed 9 solitary TZ cancers (1.8%) and RPE revealed only one of them to be truly TZ-confined cancer (0.6%). Furthermore PC-detection did not improve, even in patients with rebiopsy, and there was no correlation between detection of TZ-cancers and prostate volume. A combined use of CECD and SB to investigate participants of a PSA-screening program suggests that TZ-biopsies do not improve PC detection rate and are therefore unnecessary.