Abstract
Early detection is critical to good management of prostate cancer patients. Markers for detection, such as prostate specific antigen (PSA), and prostate biopsy are paramount for establishing an efficient diagnosis. Patients having an initial biopsy should undergo an extended biopsy scheme incorporating at least 10–12 cores, while in those undergoing a repeat biopsy particular attention should be addressed to the anterior apex. Saturation biopsies should be considered for patients with several prior negative biopsies. The chance of finding cancer on repeat biopsies has diminished in patients harboring high-grade prostatic intraepithelial neoplasia but not in those with atypical small acinar proliferation. This article reviews the history of prostate biopsy strategies with particular attention paid towards the development of extended biopsy schemes. Furthermore, a strategy is recommended for initial and repeat biopsy patients.
Key Points
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Extended biopsy schemes incorporating 10–12 cores improve cancer detection rates over sextant biopsy schemes
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Repeat biopsy schemes should include additional cores from the anterior apex as this region is undersampled in most contemporary extended biopsy schemes
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Saturation biopsies should be considered in patients with multiple negative extended biopsies and a high degree of clinical suspicion
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Extended biopsy schemes have reduced the cancer detection rates in patients demonstrating high-grade prostatic intraepithelial neoplasia on initial biopsy but not in patients with atypical small acinar proliferation
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Presti, J. Prostate biopsy strategies. Nat Rev Urol 4, 505–511 (2007). https://doi.org/10.1038/ncpuro0887
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DOI: https://doi.org/10.1038/ncpuro0887
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