CODE: 7.2 - 6-core versus saturation biopsy - a prospective analysis of the results of prostatic biopsy as a first-line procedure
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Adam Gołąb, Marcin Słojewski, Bartłomiej Gliniewicz, Andrzej Sikorski

Klinika Urologii PAM w Szczecinie

summary

Introduction. The analysis of literature on prostate biopsy leads to the conclusion that standard 6-core biopsy should be extended by additional sampling in order to improve efficacy of the method. Large quantity of specimens can be sampled by saturation biopsy. That method is usually a second-line procedure in cases of negative results of the first biopsy since in majority of centers saturation biopsy is performed under general or conduction anesthesia in the operation theatre. However, many reports emerged with reports on saturation biopsies performed under local anesthesia in the outpatient surgical setting.

Objectives. We aimed to compare the results of saturation biopsy performed under local anesthesia with the results of standard 6-core biopsy in patients who underwent prostate biopsy for the very first time.

Materials and methods. Between October 2005 and January 2006 transrectal ultrasound-guided biopsies were performed including twenty eight 6-core prostate biopsies and twenty eight 18-core saturation biopsies. The patients were randomly enrolled to one of the studied groups. Mean age was 67 years. None of the patients had previous prostate biopsy. The study enrolled patients with PSA 4.0-20.0 ng/ml. All patients underwent bilateral local anesthesia with 1% Xylocaine. Pain control was evaluated directly after biopsy using a 10-score visual analog scale (VAS). Antibiotic prophylaxis was introduced in the peri-biopsy period and during 5 days following that procedure. Two weeks after the procedure the following complications were evaluated: hematuria, bloody stools and other serious sequels requiring hospitalization. Histopathological evaluation of the bioptates was performed by 2 pathologists on every occasion.

Results. Prostate cancer was diagnosed in 18 patients (32%) including 8 (28%) who underwent standard biopsy and 10 (36%) who underwent saturation biopsy. In males with prostatic gland volume >50 cm3 the cancer was diagnosed in only 13% by means of 6-core biopsy. In comparison- the rate of positive diagnosis was 50% in patients with similar prostatic volume who underwent saturation biopsy. All patients tolerated well the procedures and mean pain score was VAS 1.3. The VAS scores were 1.1 and 1.4 for standard and saturation biopsy, respectively. Hematuria persisted 4 days on the average, and subsided earlier in patients who underwent saturation biopsy. However, the rate of hematuria was two times higher in that group. Bloody stools occurred in 1/3 of the studied patients in both groups and lasted 2.5 days on the average. Bloody stools subsided earlier in the saturation biopsy group. No serious complication following biopsy was noted.

Conclusions. Saturation prostatic biopsy shows higher efficacy than 6-core standard biopsy, especially in patients with large prostatic gland volumes. Due to good tolerance and low risk of serious complications saturation biopsy may be indicated as first-line method in diagnostics of prostatic cancer.