Title: Prostate Cancer Distribution in Patients Diagnosed by Transperineal Templateguided Saturation Biopsy
1Prostate Cancer Distribution in Patients
Diagnosed by Transperineal Template-guided
Saturation Biopsy
Edward Adamovich, MD, Gregory Merrick, MD, Sarah
Gutman, BS, Wayne Butler, PhD, Kent Wallner, MD,
Zachariah Allen, MS, Robert Galbreath, PhD,
Jonathan Lief, PhD, Richard Anderson,
BS Schiffler Cancer Center and Wheeling Jesuit
University, Wheeling, WV
Purpose
Results
Saturation biopsy parameters of the study
population
Prostate cancer diagnosis
Approximately one-third of prostate cancer cases
remain undetected by standard transrectal
ultrasound-guided biopsy. In this study, we
evaluated prostate cancer incidence, anatomic
distribution, Gleason score profile and tumor
burden in patients diagnosed by transperineal
template-guided biopsy (TTSB).
The mean patient age was 64.8 years with a mean
PSA of 9.1 ng/ml and approximate volume of 78.6
cm³. On average, patients had undergone 2.1
negative TRUS biopsy with a mean of 22.4 core
biopsies. Prostate cancer was diagnosed in 43
patients (42.2) with a Gleason score
distribution of 6 to 9. No anatomic regions of
the prostate gland were spared of cancer. In
patients with prostate cancer, an average of 9.9
cores were involved. Only three patients (7.1)
were diagnosed with clinically insignificant
cancer. In multivariate analysis, pre-saturation
biopsy diagnosis and prostate volume were the
best predictors for prostate cancer diagnosis.
Materials and Methods
One hundred two patients underwent TTSB.
Inclusion criteria included a prior negative TRUS
biopsy with a persistent elevated PSA and/or the
diagnosis of ASAP or high grade PIN. The prostate
gland was divided into 24 regional biopsy
locations. The mean number of biopsy cores was
51. Multiple clinical parameters were evaluated
as predictors for prostate cancer diagnosis.
Comparison of biopsy schemes
Distribution of prostate cancer diagnosed by
saturation biopsy
Numbering of transperineal template-guided
saturation biopsy regional biopsy locations
Cancer detection rate
Predictors for prostate cancer diagnosis by
linear regression analysis
Cancer grade and volume
Clinical parameters of the population
Cancer detection variables
Conclusion
TTSB diagnosed prostate cancer in 42.2 of
patients. Considerable anatomic variability in
prostate cancer distribution was documented.
Based on this and other reports, cancer
eradication will be dependant on treatment of the
entire prostate gland.