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Purpose: It is still not clear the role of perilesional biopsy (PL) and the extension of the random biopsy (RB) scheme to be adopted during mpMRI-guided ultrasound fusion biopsy (FB). To evaluate the increase in diagnostic accuracy achieved by PL and different RB schemes over target biopsy (TB). Methods: We collected prospectively 168 biopsy-naïve patients with positive mpMRI receiving FB and concurrent 24-core RB. The diagnostic yields of the different possible biopsy schemes (TB only; TB + 4 PL cores; TB + 12-core RB; TB + 24-core RB) were compared by the McNemar test. Clinically significant (CS) prostate cancer (PCA) was defined according to the definition of the PROMIS trial. Regression analyses were used to identify independent predictors of the presence of any cancer, csPCA. Results: The detection rate of CS cancers increased to 35%, 45%, and 49% by adding 4 PL cores, 12, and 24 RB cores, respectively (all p < 0.02). Notably, the largest scheme including 3 TB and 24 RB cores identified a small but statistically significant 4% increase in detection rate of CS cancer, as compared with the second largest scheme. TB alone identified only 62% of the CS cancers. Such figure increased to 72% by adding 4 PL cores, and to 91% by adding 14 RB cores. Conclusions: We found that PL biopsy increased the detection rate of CS cancers as compared with TB alone. However, the combination of those cores missed about 30% of the CS cancers identified with larger RB cores, notably including a considerable 15% of cases located contralaterally to the index tumor. [ABSTRACT FROM AUTHOR]

Introduction: The reclassification rate for clinically significant prostate cancer (csPCa) in men enrolled in Active Surveillance (AS) as been prospectively evaluated. Patients and Methods: One hundred patients with very low risk PCa underwent after 8 years a scheduled transperineal prostate biopsy (SPBx = 20 cores) combined with additional mpMRI/TRUS fusion biopsies (4 cores) of lesions PI-RADS scores = 3. All the patients, after initial diagnosis, previously had mpMRI evaluation combined with transperineal saturation prostate biopsy (confirmatory and 3-year scheduled biopsy). Risk reclassification at repeat biopsy triggering the recommendation for active treatment was defined as over 3 or more than 10% of positive cores, Gleason score > 6/ISUP Grade Group = 2, greatest percentage of cancer (GPC) > 50%. Results: Multiparametric MRI was suspicious (PI-RADS = 3) in 30 of 100 cases (30.0%); 70 (70.0%) vs. 20 (20.0%) vs. 10 (10.0%) patients had a PI-RADS score ≤ 2 vs. 3 vs. 4, respectively. Two (2.0%) patients with PI-RADS score 3 and 4 were upgraded (ISUP Grade Group 2); SPBx and MRI/TRUS fusion biopsy diagnosed 100% and 0% of csPCa, respectively. Conclusions: Transperineal SPBx combined with mpMRI at initial confirmatory biopsy allow to select an high number of men at very low risk of reclassification during the AS follow up (2.0% of the cases at 8 years from diagnosis); these data could be useful to reduce the number of scheduled repeated prostate biopsy during the AS follow up. [ABSTRACT FROM AUTHOR]

Alberto Artiles Medina, Rafael Rodríguez-Patrón Rodríguez, Mercedes Ruiz Hernández, Marina Mata Alcaraz, Silvia García Barreras, Guillermo Fernández Conejo, Agustín Fraile Poblador, Enrique Sanz Mayayo, Francisco Javier Burgos Revilla Department of Urology, Hospital Universitario Ramón y Cajal, University of Alcalá, Madrid, SpainCorrespondence: Alberto Artiles MedinaDepartment of Urology, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, Madrid, 28034, SpainTel +91.336.87.60Fax +91.336.87.59Email alberc.artiles@gmail.comPurpose: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario.Patients and Methods: A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥ 20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging – Reporting and Data System, PI-RADS, ≤ 2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa.Results: The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93– 63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume > 50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01– 0.94, p=0.04).Conclusion: A free:total PSA ratio < 20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI.Keywords: clinically significant prostate cancer, multi-parametric magnetic resonance imaging, negative MRI, prostate cancer, saturation biopsy

Introduction: The reclassification rate for clinically significant prostate cancer (csPCa) in men enrolled in Active Surveillance (AS) as been prospective-ly evaluated. Patients and methods: One hundred patients with very low risk PCa underwent after 8 years a scheduled transperineal prostate biopsy (SPBx = 20 cores) combined with additional mpMRI/TRUS fusion biopsies (4 cores) of lesions PI-RADS scores ≥ 3. All the patients, after initial diagnosis, previously had mpMRI evaluation combined with transperineal saturation prostate biopsy (confirmatory and 3-year scheduled biopsy). Risk reclassification at repeat biopsy triggering the recommen-dation for active treatment was defined as over 3 or more than 10% of positive cores, Gleason score > 6/ISUP Grade Group ≥ 2, greatest percentage of cancer (GPC) > 50%. Results: Multiparametric MRI was suspicious (PI-RADS ≥ 3) in 30 of 100 cases (30.0%); 70 (70.0%) vs. 20 (20.0%) vs. 10 (10.0%) patients had a PI-RADS score ≤ 2 vs. 3 vs. 4, respec-tively. Two (2.0%) patients with PI-RADS score 3 and 4 were upgraded (ISUP Grade Group 2); SPBx and MRI/TRUS fusion biopsy diagnosed 100% and 0% of csPCa, respectively. Conclusions: Transperineal SPBx combined with mpMRI at ini-tial confirmatory biopsy allow to select an high number of men at very low risk of reclassification during the AS follow up (2.0%of the cases at 8 years from diagnosis); these data could be use-ful to reduce the number of scheduled repeated prostate biopsy during the AS follow up.

Purpose: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario. Patients and Methods: A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥ 20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging – Reporting and Data System, PI-RADS, ≤ 2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa. Results: The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93– 63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume > 50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01– 0.94, p=0.04). Conclusion: A free:total PSA ratio < 20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI. [ABSTRACT FROM AUTHOR]

SPBx combined with mpMRI at confirmatory and repeated evaluation allow to select an high number of men at very low risk of reclassification during the AS follow up (5.4% of the cases at 3 years from diagnosis); these data could be useful to reduce the number of scheduled repeated prostate biopsy during the AS follow up. Introduction: The reclassification rate for clinically significant prostate cancer (csPCa) has been evaluated in men enrolled in active surveillance (AS) protocol who previously underwent confirmatory biopsy. Materials and Methods: From May 2013 to September 2017, 110 patients (median age 63 years) with very low risk PCa underwent 3-years scheduled prostate biopsy performing repeated transperineal saturation biopsy (SPBx); in addition, the mpMRI lesions characterized by Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores = 3 were submitted to additional mpMRI/TRUS fusion biopsies (4 cores). The reclassification rate for csPCa (over 3 or more than 10% of positive cores, ISUP Grade Group/GG = 2, greatest percentage of cancer > 50%) has been evaluated. Results: Six (5.4%) patients with PI-RADS score 3 (4 men) vs. 4 (2 men) were reclassified based on upgraded (GG2); SPBx and MRI/TRUS fusion biopsy diagnosed 100% and 0% of csPCa, respectively. Of the remaining 104 (94.5%) patients, 75 (72.2%) were found to have very low-risk PCa and in 29 (27.8%) cancer was absent (normal parenchyma). Conclusion: SPBx combined with mpMRI at confirmatory and repeated evaluation allow to reduce the reclassification rate during AS follow up (5.4% of the cases at 3 years from diagnosis). [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of core length on cancer detection in saturation prostate biopsy. We hypothesized that increasing mean and total core length in saturation prostate biopsy may allow more tissue sampling, thus, may increase the prostate cancer detection rate. Materials and Methods: We retrospectively analyzed medical records of 145 patients who underwent 24-core transrectal ultrasound-guided saturation biopsy at our institution. We evaluated the clinopathological factors, including age, prostate specific antigen (PSA), prostate volume, mean core length and the total biopsy core length. The patients were divided into 3 groups according to their total biopsy core length; group 1: 30 cm. These groups were compared according to age, PSA value, prostate volume and cancer detection rate. Results: The mean age, core length and total core length were 62.4±7.0 years, 10.91±1.8 mm, and 26.2±4.7 cm, respectively. The overall cancer detection rate was 33.8%. There was no statistically significant difference in mean core length and total core length between patients diagnosed with prostate cancer and those without it. The cancer detection rates in group 1, 2 and 3 were 25%, 37.4% and 23.1%, respectively. When these 3 groups were compared with each other, group 2 had a statistically significantly higher cancer detection rate relative to group 1 (p=0.001). Multivariate analysis showed no statistically difference in cancer detection rate between the groups (p=0.302). Conclusion: Mean and total core length may not have any significant effect on prostate cancer detection in patients undergoing saturation prostate biopsy.

Objective: Saturation biopsy is more sensitive than transrectal biopsy in the detection of prostate cancer but is an invasive method and has a risk of overdiagnosis. Multiparametric magnetic resonance imaging (mpMRI) provides imaging and working information of the prostate. The purpose of the study was to compare the performance of pelvic phased-array mpMRI against saturation biopsies in men with suspected advanced prostate cancer considering pathology of the surgical specimen as the reference standard. Materials and methods: Data of men (n = 81) with prostate-specific antigen >10 ng/mL, low free-to-total ratio <0.1, and/or prostate-specific antigen density >0.15 who underwent mpMRI and saturation biopsy prior to radical prostatectomy were reviewed. The mpMRI was characterized as per Prostate Imaging Reporting and Data System v2.1. Gleason scores ≥3 + 4 were considered as prostate cancer. The beneficial score was evaluated for each diagnostic method for the decision-making of prostatectomy. Results: mpMRI was positive in 72 men, while saturated biopsies reported 57 men with positive prostate cancer. The histopathology of the surgical specimen reported prostate cancer in 76 men. mpMRI and saturated biopsies reported 0.934 and 0.737 sensitivities and 0.926 and 0.741 specificities, respectively. mpMRI had cancer detectability between 0.55 and 0.965 diagnostic confidence and saturation biopsies had cancer detectability between 0.85 and 0.952 diagnostic confidence. Above 0.965 and 0.952 diagnostic confidence, mpMRI and saturation biopsies had the risk of overdiagnosis. Conclusions: mpMRI can provide additional information for the detection of prostate cancer before saturation biopsies. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Abstract Background We evaluated the cancer detection rate of prostate cancer using transperineal template-guided saturation biopsy aimed at sampling one core for each milliliter of prostate volume for patients requiring repeated prostate biopsies. Methods In total, 103 consecutive patients with repeated prostate biopsies were enrolled in this retrospective study. The number of biopsy cores was defined by prostate volume. In principle, one biopsy core covered 1 mL of prostate volume. We used a prostate brachytherapy template with a 5-mm grid and adopted a transperineal needle biopsy. Results The median age, prostate-specific antigen level, and prostate volume were 69 (range, 37–83) years, 9.2 (range, 1.9–107) ng/mL, and 34.7 (range, 18–76.7) mL, respectively. The median number of biopsy cores was 37 (range, 18–75 cores). Fifty-three patients (51.5%) were diagnosed with prostate cancer. The Gleason score was 6, 7, and 8–10 in 24.5, 64.2 and 11.3% patients, respectively. Forty-two patients (79.2%) were diagnosed with clinically significant PCa. Acute urinary retention was detected in 2 patients (1.9%). Conclusions Transperineal template-guided saturation biopsy with one core per milliliter of prostate volume helped achieve a high cancer detection rate and high significant cancer detection rate with acceptable biopsy-associated adverse events.

Purpose : The aim of this work is to evaluate results of prostate transperineal saturation biopsy as a guide for focal high-dose-rate brachytherapy in patients with prostate cancer (PCa). Material and methods: Template guided saturation biopsy was performed in 67 primary patients with suspicion for prostate cancer. Biopsy was performed under ultrasonography (US) control with the help of brachytherapy grid and 5 mm distance between samples. We put special attention for accurate sampling of prostate in periurethral region. The number of cores varied from 17 to 81 (average 36 cores). Finally, in 40 patients with confirmed prostate cancer results of biopsy were used for brachytherapy planning. Results : Saturation biopsy revealed prostate cancer in 40 of 67 evaluated patients. The extent of biopsy core involvement varied from 5% to 100% (average: 57%). Focal nature of PCa (single unilateral tumor nodule) was diagnosed in 10 (25%), multifocal – in another 30 (75%) patients. Hemigland invasion was mentioned in 12 (30%) cases. Saturation biopsy detected PCa in periurethral cores in 27 (67.5%) of 40 evaluated patients. In 10 patients, the extent of involvement in periurethral cores varied between 10% and 50%; in another, 17 observations exceeded 50%. According to results obtained on saturation biopsy, we performed HDR brachytherapy with “urethra low dose tunnel” (D10ur ≤ 80-90%) in 13 patients with noninvolved periurethral cores. Theoretically, hemigland brachytherapy was possible in 12 of 40 evaluated patients with PCa. Conclusions : In low risk patients with PCa results of template guided saturation biopsy indicates high frequency (75%) of multifocal disease and high probability (67.5%) of periurethral invasion. Suitable candidates for focal HDR brachytherapy or irradiation with additional sparing of urethra can be effectively determined with the help of saturation biopsy.

Objective: To investigate the effect of core length on cancer detection in saturation prostate biopsy. We hypothesized that increasing mean and total core length in saturation prostate biopsy may allow more tissue sampling, thus, may increase the prostate cancer detection rate. Materials and Methods: We retrospectively analyzed medical records of 145 patients who underwent 24-core transrectal ultrasound-guided saturation biopsy at our institution. We evaluated the clinopathological factors, including age, prostate specific antigen (PSA), prostate volume, mean core length and the total biopsy core length. The patients were divided into 3 groups according to their total biopsy core length; group 1: <20 cm, group 2: 20-30 cm and group 3: >30 cm. These groups were compared according to age, PSA value, prostate volume and cancer detection rate. Results: The mean age, core length and total core length were 62.4±7.0 years, 10.91±1.8 mm, and 26.2±4.7 cm, respectively. The overall cancer detection rate was 33.8%. There was no statistically significant difference in mean core length and total core length between patients diagnosed with prostate cancer and those without it. The cancer detection rates in group 1, 2 and 3 were 25%, 37.4% and 23.1%, respectively. When these 3 groups were compared with each other, group 2 had a statistically significantly higher cancer detection rate relative to group 1 (p=0.001). Multivariate analysis showed no statistically difference in cancer detection rate between the groups (p=0.302). Conclusion: Mean and total core length may not have any significant effect on prostate cancer detection in patients undergoing saturation prostate biopsy. [ABSTRACT FROM AUTHOR]

To evaluate the role of the patient’s mood as a possible cause of erectile dysfunction (ED) following transrectal ultrasound-guided saturation biopsy.

Saturation prostate biopsy protocols have been developed to improve the prostate cancer (PCa) detection rate, particularly in the setting of repeat biopsies. The present study attempted to clarify the association between PCa detection and various risk factors in repeat saturation biopsies. A retrospective analysis was conducted on 78 Japanese patients for whom findings had caused suspicion of PCa despite previous negative prostate biopsies, and who consecutively underwent a 24-core transperineal repeat biopsy at Toyama University Hospital (Toyama, Japan). PCa was confirmed histologically in 16 of the 78 patients (20.5%). A univariate analysis revealed that the prostate-specific antigen (PSA) level at repeat biopsy was higher (P<0.01), the fPSA/tPSA ratio was lower (P=0.04), the total prostate volume was smaller (P=0.01) and the PSA density was higher (P<0.01) in PCa patients than in patients with benign prostatic disease (BPD). Histological inflammation was more frequently observed in BPD patients than in PCa patients (P<0.01). A multivariate analysis revealed that histological inflammation was the only independent predictor of the presence of a malignant lesion on repeat biopsy (odds ratio, 0.027; P=0.01). It must be considered that inflammation may cause a PSA increase in some patients with a negative initial biopsy, leading to unnecessary repeat biopsy. [ABSTRACT FROM AUTHOR]

Results of patient feedback questionnaire following transperineal template guided saturation biopsy (TPSB) without prophylactic catheterisation. Introduction and Objective: TPSB is increasingly utilised in the diagnosis and characterisation of prostate cancer. However, there is little data on patient experience after undergoing this procedure. We circulated a questionnaire to 511 consecutive patients from July 2007 to December 2014 and now analyse the responses. Materials and Methods: The mean age for the cohort was 64 (range 43-82). A mean of 28 biopsy cores (range 13-43) were taken under general anaesthesia (GA), as day case procedure. Patients received diclofenac 100 mg suppository on completion of the procedure. The questionnaire explored symptoms at 1 h, 1, 3 and 7 days postoperatively. Results: There were 301 responses (59%). Following TPSB, 38% initially experienced rectal bleeding, falling significantly to 3% on day 7 (p < 0.001) and it was not a serious condition in all cases. A majority reported haematuria at 1 h but persisting at 1 week in over one quarter (p < 0.001). Nevertheless, although initially often dark, none had other than pale pink by the end of the reporting period. In contrast, the incidence of haematospermia increased over 7 days, rising significantly to 38% by this stage (p < 0.001). Several patients commented that the procedure was more tolerable than their previous conventional TRUS biopsy and 20 (6.6%) with voiding difficulty required catheterisation. In all, 23% patients felt pain, and out of these 23% only 5% required minor analgesia at day 7. Conclusion: TPSB under GA without prophylactic catheterisation is well tolerated, carrying acceptable postoperative symptom rates. Interestingly, a significant proportion of patients ejaculate within 7 days, which again suggests good tolerance to the procedure. Patients should be provided with this data preoperatively when they are considering TPSB. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this work is to evaluate results of prostate transperineal saturation biopsy as a guide for focal high-dose-rate brachytherapy in patients with prostate cancer (PCa). Material and methods: Template guided saturation biopsy was performed in 67 primary patients with suspicion for prostate cancer. Biopsy was performed under ultrasonography (US) control with the help of brachytherapy grid and 5 mm distance between samples. We put special attention for accurate sampling of prostate in periurethral region. The number of cores varied from 17 to 81 (average 36 cores). Finally, in 40 patients with confirmed prostate cancer results of biopsy were used for brachytherapy planning. Results: Saturation biopsy revealed prostate cancer in 40 of 67 evaluated patients. The extent of biopsy core involvement varied from 5% to 100% (average: 57%). Focal nature of PCa (single unilateral tumor nodule) was diagnosed in 10 (25%), multifocal - in another 30 (75%) patients. Hemigland invasion was mentioned in 12 (30%) cases. Saturation biopsy detected PCa in periurethral cores in 27 (67.5%) of 40 evaluated patients. In 10 patients, the extent of involvement in periurethral cores varied between 10% and 50%; in another, 17 observations exceeded 50%. According to results obtained on saturation biopsy, we performed HDR brachytherapy with "urethra low dose tunnel" (D10ur ⩽ 80-90%) in 13 patients with noninvolved periurethral cores. Theoretically, hemigland brachytherapy was possible in 12 of 40 evaluated patients with PCa. Conclusions: In low risk patients with PCa results of template guided saturation biopsy indicates high frequency (75%) of multifocal disease and high probability (67.5%) of periurethral invasion. Suitable candidates for focal HDR brachytherapy or irradiation with additional sparing of urethra can be effectively determined with the help of saturation biopsy. [ABSTRACT FROM AUTHOR]

Purpose: Stereotactic biopsy has improved prostate cancer detection. Although the new approach is superior, standard procedure is still useful in a cohort of patients in whom MRI is not available. The standard saturation biopsy technique is still debatable. We describe our technique and analyze its outcomes. Materials and methods: One hundred twenty-five patients underwent saturation biopsy through a single transperineal access. Mean age was 64.73 year, mean PSA was 9.49 ng/ml, mean PSA density was 0.184, and mean prostate volume was 57.95 g. All patients underwent at least one previous prostatic biopsy: 24.8 % of cases had diagnosis of atypical small acinar proliferation, 39.2 % of cases had multifocal high-grade prostatic intraepithelial neoplasia, and 36 % of cases had inflammation or benign prostatic hyperplasia. Results: The detection rate was 38.4 %. Prostate cancer occurred in 61.3 % of patients with previous ASAP ( p < 0.007). Cancer detection rate decreased with increasing number of previous biopsy and with increasing prostate volume ( p < 0.001) and increased with increasing PSA density ( p = 0.03). No major complications were reported. Conclusion: The traditional saturation biopsy may be useful when targeted biopsy cannot be used. Our technique is accurate for cancer detection. It can offer some advantages in comparison with other approaches. [ABSTRACT FROM AUTHOR]

Objective To evaluate the role of the patient's mood as a possible cause of erectile dysfunction (ED) following transrectal ultrasound-guided saturation biopsy. Materials and Methods One hundred and thirty five patients who underwent a saturation biopsy due to persistently elevated levels of prostate specific antigen (PSA) were included in the study. Group 1 included 78 patients for whom the biopsy indicated that they were cancer-free, and group 2 included 57 patients for whom the biopsy indicated that they had prostate cancer and were thus on a waiting list for a radical treatment. Patients were evaluated using the International Index of Erectile Function-5 (IIEF-5) and the Hospital Anxiety-Depression Scale (HADS). Results Among the cancer-free group, 17% of patients exhibited a decline in erectile function after the biopsy according to their IIEF-5 scores. The anxiety or depression rate according to the HADS was 69% in the patients exhibiting a decrease in erectile function, which was greater than that of the rest of the cancer-free patients who had no erectile function deterioration. Patients who learned that they had cancer exhibited a statistically significant average decrease in IIEF-5 scores (p=0.04). Their scores on the HADS were significantly higher. Conclusion Although a saturation biopsy of the prostate is a safe procedure in terms of erectile function, the risk of ED after a biopsy should be discussed with patients who have had previous normal erectile function and have been diagnosed with cancer. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the detection rate of anterior zone (AZ) prostate cancer (PCa) in patients submitted to initial and repeat transperineal prostate biopsy. Methods: From January 2013 to August 2013, 226 patients (median age 64 years) with negative digital rectal examination underwent initial (144 cases) and repeat (82 cases) transperineal prostate biopsy for PSA >10 ng/ml, PSA 4.1-10.0 or 2.6-4.0 ng/ml with free/total PSA ≤25% and ≤20%, respectively. A median of 22 versus 32 cores were performed, including 4 cores of the AZ versus 6 cores (4 anterior plus 2 cores of the transition zone, TZ) at initial versus repeat biopsy, respectively. The detection rate of PCa of the peripheral zone (PZ), AZ and TZ was prospectively evaluated. Results: The median PSA was 7.6 ng/ml; overall, a stage cT1c PCa was found in 104/226 (46%) patients, in 70 (48.6%) and 34 (41.5%) of the men who underwent initial and repeat biopsy, respectively. An AZ PCa was found in 11.5 vs. 8.8% (p = 0.32) of the patients submitted to initial versus repeat biopsy, respectively. AZ cancers demonstrated a number of positive cores (p = 0.03), greatest percentage of cancer (p = 0.001) and total percentage of cancer (p = 0.001) significantly lower in comparison with PZ PCa; moreover, 56.2 vs. 36.5% of AZ versus PZ PCa were characterized by a microfocus of cancer (p = 0.001), respectively. Conclusions: AZ biopsies increase the detection rate of PCa (about 10% of cases) at initial and repeat biopsy, allowing reduction of the biopsy false-negative rate. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background The prostatic anterior zone (AZ) is not targeted routinely by TRUS guided prostate biopsy (TRUS-Pbx). MRI is an accurate diagnostic tool for AZ tumors, but is often unavailable due to cost or system restrictions. We examined the diagnostic yield of office based AZ TRUSPbx. Methods 127 men at risk for AZ tumors were studied: Patients with elevated PSA and previous extended negative TRUS-Pbx (group 1, n = 78) and actively surveyed low risk prostate cancer patients (group 2, n = 49). None of the participants had a previous AZ biopsy. Biopsy template included suspicious ultrasonic areas, 16 peripheral zone (PZ), 4 transitional zone (TZ) and 6 AZ cores. All biopsies were performed by a single urologist under local periprostatic anaesthetic, using the B-K Medical US System, an end-firing probe 4-12MHZ and 18ga/25 cm needle. All samples were reviewed by a single specialized uro-pathologist. Multivariate analysis was used to detect predictors for AZ tumors accounting for age, PSA, PSA density, prostate volume, BMI, and number of previous biopsies. Results Median PSA was 10.4 (group 1) and 7.3 (group 2). Age (63.9, 64.5), number of previous biopsies (1.5) and cores (17.8, 21.3) and prostate volume (56.4 cc, 51 cc) were similar for both groups. The overall diagnostic yield was 34.6% (group 1) and 85.7% (group 2). AZ cancers were detected in 21.8% (group 1) and 34.7% (group 2) but were rarely the only zone involved (1.3% and 4.1% respectively). Gleason ≥ 7 AZ cancers were often accompanied by equal grade PZ tumors. In multivariate analysis only prostate volume predicted for AZ tumors. Patients detected with AZ tumors had significantly smaller prostates (36.9 cc vs. 61.1 cc p < 0.001). Suspicious AZ ultrasonic findings were uncommon (6.3%). Conclusions TRUS-Pbx AZ sampling rarely improves the diagnostic yield of extended PZ sampling in patients with elevated PSA and previous negative biopsies. In low risk prostate cancer patients who are followed by active surveillance, AZ sampling changes risk stratification in 6% but larger studies are needed to define the role of AZ sampling in this population and its correlation with prostatectomy final pathological specimens. [ABSTRACT FROM AUTHOR]

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Objectives To examine the ability of standard and saturation transrectal prostate biopsy techniques to predict appropriate candidates for active surveillance. Methods Between 2005 and 2007, 500 consecutive patients underwent transrectal ultrasound-guided biopsy by a standard template (12 cores) or saturation template (≥18 cores, median 27 cores), with subsequent radical prostatectomy. Using the criteria of Gleason score ≤6, clinical stage T1 or T2a, prostate-specific antigen <10 and ≤33% of cores involved, 218 patients were potential candidates for active surveillance. Pathology results from the prostatectomy specimens were used to determine the accuracy of each biopsy technique. Biochemical failure after prostatectomy was evaluated using logistic and Cox proportional hazards regression. Results A standard biopsy was carried out for 124 patients and saturation biopsy for 94 patients. There was no statistically significant difference between the groups in terms of median age ( P = 0.14), preoperative prostate-specific antigen ( P = 0.52) and clinical stage ( P = 0.23). Similar rates of Gleason score ≥7 at the time of radical prostatectomy were found, with 14% for standard biopsy and 15% for saturation biopsy ( P = 0.70). Upstaging was shown in two standard biopsy patients (1.6%) and no saturation biopsy patients ( P = 0.62). A multivariate analysis adjusting for prior prostate biopsy, preoperative prostate-specific antigen and clinical stage showed no difference in the rate of upgrading based on biopsy technique ( P = 0.26). During follow up, 5-year biochemical failure-free survival estimates were not significantly different ( P = 0.11). Conclusions In men with prostate cancer, standard and saturation transrectal prostate biopsies techniques are equally predictive of candidates for active surveillance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prostate cancer (CaP) detection rate and morbidity of performing a transurethral resection biopsy of the prostate (TURBP) at the same time as a saturation biopsy (SBx). Patients: A total of 102 men with previous negative transrectal ultrasound (TRUS) biopsies underwent a SBx under formal anaesthesia. Fifty-four [54 (52.9%)] had a combined SBx and TURBP (Group 1) and 48 (47.1%) had a SBx only (Group 2). Results: The CaP detection rate in Group 1 was 38.9% (21/54), which was significantly higher than the detection rate of 27.1% (13/48) in Group 2 (P = 0.005). CaP was detected via TURBP in 12 patients (22.2%) from Group 1, including 8 (14.8%) patients who had CaP solely in their TURBP chips. According to the D'Amico classification. 66.6% (14/21) of the cancers in Group 1 were intermediate (n = 4) or high risk (n = 10). Of the 8 'TURBP only' cancers, 75% (6/8) were intermediate (n = 2) or high risk (n = 4). Seven of these eight patients went on to have a radical prostatectomy (RP) but only 2 (28.6%) were found to have a pure anterior/transition zone (TZ) tumor. The postoperative urinary retention and emergency admission rates for Groups 1 and 2 were 29.6% (16/54) vs. 16.6% (8/48) (P = 0.095) and 11.1% (6/54) vs. 5.5% (2/48) (n = 0.17). There was no difference in terms of hematuria (P = 0.54), urinary tract infection (UTI) (P = 0.22), or sepsis (P = 0.21), and patients in Group 1 spent an average of 0.5 days longer in hospital (1.9 vs. 1.4; P = 0.008). Conclusions: TURBP in association with SBx increases the detection of clinically important CaP. However, this does have to be balanced against the small increased incidence of urinary retention, emergency re-admission, and longer hospital stay. [ABSTRACT FROM AUTHOR]

The prostate-specific antigen (PSA) era has increased the rates of prostate cancer detection and treatment, while reducing the risk of death from prostate cancer in the US. Image-guided prostate biopsy techniques have led to stage migration and the detection and treatment of lower risk prostate cancers. Improved techniques with laterally directed biopsy, office-based saturation biopsy, and transperineal biopsy under anesthesia have increased the detection rates of smaller volume tumors. Improved detection of ever-smaller tumors assists the clinician in determining what treatment is most appropriate for the patient, including the use of active surveillance and focal therapy. Furthermore, the detection of small volume, high grade cancers may widen the latency interval in which a clinically significant tumor may be detectable and curable. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Men with persistent suspicion for prostate cancer after previous negative standard transrectal biopsy series are offered saturation biopsy either transrectally or transperineally to increase cancer detection rate. A high-risk group of men with at least two previous negative transrectal biopsies underwent transperineal template-guided saturation biopsy. Prostate cancer was detected in 26%, predominantly in the anterior zones. PSA velocity or doubling time were the most powerful factors to predict cancer. OBJECTIVE To evaluate the detection rate and the regional location of prostate cancer in men undergoing transperineal template-guided saturation biopsy (TTSB)., PATIENTS AND METHODS In all, 92 consecutive men with at least two previous negative transrectal biopsy series who underwent a multiple-core prostate TTSB at our centre were included in the study., Univariable and multivariable logistic regression analyses were used to address the relationship between parameters before TTSB and prostate cancer-detection rate., Covariates consisted of age at biopsy, free and total prostate-specific antigen (PSA), prostate volume, digital rectal examination findings, histological findings on previous biopsy, PSA velocity (PSAV), PSA-doubling time (PSADT) and the number of previous negative biopsy sets., RESULTS Prostate cancer was diagnosed in 26% of the men., A median of 30 cores was taken by TTSB., Adenocarcinoma in >2 cores was detected in 58.5% and Gleason score ≥7 was detected in 46% of the diagnosed men., Most of the tumours (83.3%) were found in the anterior zones of the gland, with a significantly higher number of positive cores vs the posterior zones (mean 4.9 vs 1.5, P= 0.015)., PSADT and PSAV were the only independent predictors of prostate cancer detection at multivariate analyses with odds ratios of 0.71 ( P= 0.014) and 1.58 ( P= 0.025), respectively., CONCLUSIONS TTSB has a high prostate cancer-detection rate, especially in the anterior zones., Men after at least two previous negative transrectal biopsy series and persistent suspicion of prostate cancer, as evidenced by rapid PSA dynamics, should be offered TTSB. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The Partin tables represent a widely used tool to predict final pathologic stage in men with localized prostate cancer. The study provides a validity assessment of the current Partin tables' version, and compares data sets from patients with prostate cancers detected by different biopsy schedules for potential differences in predictive accuracy. OBJECTIVE To analyse the overall accuracy of Partin tables, with special emphasis to potential limitations resulting from differences between prostate cancers detected by different biopsy schedules., PATIENTS AND METHODS Clinical characteristics from 599 patients treated with radical prostatectomy defined the 2007 Partin probabilities of organ confinement (OC), seminal vesicle invasion (SVI) and extracapsular extension (ECE). Prostate cancers were detected by initial biopsy (IBx) with ≤12 cores in 405 patients (67.6%), by conventional repeat biopsy (CRBx) with ≤12 cores in 99 (16.5%) and by saturation repeat biopsy (SRBx) with ≥20 cores in 95 patients (15.9%)., The area under the curve (AUC) estimated by the receiver operating characteristic curve, assessed the predictive accuracy of the 2007 Partin tables., RESULTS The Partin tables AUC of the IBx, CRBx and the SRBx groups were 0.730 vs 0.701 vs 0.585 for OC, 0.631 vs 0.689 vs 0.547 for ECE, and 0.775 vs 0.755 vs 0.641 for SVI, respectively., CONCLUSIONS The overall accuracy of the 2007 Partin tables was clearly inferior in patients with prostate cancers detected by SRBx., Prostate cancers detected by SRBx undermine the Partin tables' overall accuracy, and this group of patients may be miscounselled by vague predictions. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Multifocality, age, PSA values, and biopsy protocols regarding the predictive value of high grade PIN have been discussed extensively in the literature. Our study developed for the first time a predictive nomogram that could be helpful for patient counselling and to guide the urologist to perform rPBX after an initial diagnosis of isolated HGPIN. OBJECTIVE To evaluate factors that may predict prostate cancer (PCa) detection after the initial diagnosis of high-grade prostatic intra-epithelial neoplasia (HGPIN) on prostate biopsy (PBx) with six to 24 random cores. [ABSTRACT FROM AUTHOR]

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