The Rebiopsy with saturation technique.

Andrea Fandella1, Sara Benvenuto1
  • 1 Casa di Cura Giovanni XXIII, Divisione di Urologia (Monastier )

Objective

The diagnostic yield of a first transrectal ultrasound guided biopsy is commonly 40–50% [2]. This represents a significantly high detection rate from a primary diagnostic intervention. It is however known that first-line prostate biopsy protocols such as traditional TRUS-B, even when used as an extended biopsy protocol of 12 cores will miss about 30% of prostate cancers [3]. Cancer detection rates in repeat TRUS-B range from 18% [4] to 32% [5]. Cancer will still be detected after multiple repeat TRUS-Bs, though the cancer detection rate falls with each repeat biopsy episode [6]. Even so the standard TRUS-B only allows limited access to the prostate and from the same anatomical approach, typically resulting in undersampling of the prostatic apex and anterior region of the gland [7].

A number of different techniques for prostate re-biopsy have been developed and tested in an attempt to improve cancer detection rates following an initial negative biopsy. These include saturation biopsy approaches (either transperineal or transrectal) or image guided (typically Magnetic Resonance Imaging) biopsies. In the initial biopsy setting it has been shown that the use of saturation biopsy techniques, which obtain greater number of prostate cores, either by transrectal or transperineal routes have no advantage over standard TRUS-B with respect to cancer detection rate [8], [9]. In the repeat biopsy setting however, it is known that the use of saturation biopsy detects more cancer than TRUS-B alone [3], [10]. To evaluate the "detection rate" of prostate cancer (PC) in patients undergoing second biopsy technique with saturation 24 sample.

Methods and results

In the period 1.2010 – 12.2012 we performed consecutively in 320 patients with rebiopsy "saturation biopsy" [62aa mean age (range 50 – 74), PSA 13.53ng/ml average (range 4.6 23), negative DRE.
What remains unclear from the existing literature is which repeat biopsy strategy offers the highest cancer detection rate in patients with a negative TRUS-B but ongoing suspicion of prostate cancer.
Each patient had already been subjected to at least one previous set biopsy with a number average of 10 samples (8-12). This indication was previous diagnosis of PIN / ASAP in 24 (16 pts PIN / ASAP 8 patients) or abnormal increase in the PSA.
Each examination, performed outpatient basis, was conducted by transrectal with with peripheral block, using a schema biopsy default to 24 samples.

Discussion

Running extended mapping biopsy ("saturation biopsy") is recommended for patients at high risk for prostate cancer (PC) in order to increase the "detection rate".
The incidence of CP after one or more series biopsy negative is not yet known, but in the presence of risk factors seems to be justified to the procedure of saturation to give an answer to the patient.

A negative histology after a limited rebiopsia often imposes additional biopsies, especially in the presence of risk factors, and does not exclude the presence of CP. Saturation biopsy does not exclude completly this risk but provides better detection rate and allows only negative deferring the eventual rebiopsy.

References

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