A randomised trial comparing two protocols for transrectal prostate repeat biopsy: six lateral posterior plus six anterior cores versus a standard posterior 12-core biopsy. (4th July 2019)

• Record Type: Journal Article
• Authors: Örtegren, Joakim; Holmberg, Jan Tage; Lekås, Edvard; Mana, Sabah; Mårtensson, Stig; Richthoff, Jonas; Sundqvist, Pernilla; Kjölhede, Henrik; Bratt, Ola; Liedberg, Fredrik
• Is Part Of: Scandinavian journal of urology. Volume 53:Number 4(2019)
• Page Start: 217
• Page End: 221
• Publication Date: 2019-07-04
• Subjects: Prostate cancer -- rebiopsy -- end-fire -- side-fire -- randomized -- anterior biopsies; Urology -- Periodicals; 616.6
• DOI: 10.1080/21681805.2019.1628102
• Languages: English
• ISSNs: 2168-1805

Abstract

Abstract: Objective: To test the hypothesis that a combination of 6 posterior and 6 anterior cores detects more cancer than 12 posterior cores at a repeat transrectal prostate biopsy in men who have had one previous benign systematic biopsy. Patients and methods: Three hundred and forty men with persistently raised serum PSA were randomly allocated 1:1 to either a standard 12-core biopsy (12 cores from the lateral peripheral zone through a side-fire biopsy canal) or an experimental 12-core biopsy protocol with 6 anterior cores through an end-fire biopsy canal and 6 cores from the lateral peripheral zone through a side-fire biopsy canal. All biopsies were obtained transrectally with ultrasound guidance. The primary endpoint was cancer detection. Secondary endpoints were detection of ISUP Grade Groups/Gleason Grade Group ≥2 cancer, total biopsy cancer length and complications leading to medical intervention. Results: Prostate cancer was detected in 42/168 men (25%) in the experimental biopsy group and in 36/172 (21%) in the standard biopsy group ( p = 0.44). The corresponding proportions for Gleason score ≥7 were 12% and 7% ( p = 0.14). Median total cancer length was 4 (inter quartile range [IQR] = 1.5 − 6) mm in the end-fire group and 3 (IQR = 1.3 − 7) mm in the side-fire group. Ten men in the end-fire group and three in the side-fire group had a medical intervention for biopsy-related complications ( p = 0.05). Conclusion: The biopsy protocol that included six end-fire anterior cores did not detect more cancer and was associated with more complications. Trial registration: ClinicalTrials.gov identifier: NCT02761135.