Prostate Biopsy: Indications and Technique

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Review Article1 Jan 2003Prostate Biopsy: Indications and Technique BRIAN R. MATLAGA, L. ANDREW ESKEW, and DAVID L. McCULLOUGH BRIAN R. MATLAGABRIAN R. MATLAGA , L. ANDREW ESKEWL. ANDREW ESKEW , and DAVID L. McCULLOUGHDAVID L. McCULLOUGH View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64024-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The last decade has seen numerous modifications in the way prostate cancer is diagnosed. We review the current indications for and methods of prostate biopsy. Materials and Methods: The English language literature was reviewed regarding major indications for and methods of prostate biopsy. Pertinent peer reviewed articles were collated and analyzed. Results: The most widely accepted indication for prostate biopsy is a prostate specific antigen (PSA) value of greater than 4.0 ng./ml. However, some investigators advocate prostate biopsy for men with a PSA value in the 2.5 to 4.0 ng./ml. range, believing that use of this parameter results in detection of a greater number of cases of curable disease. Age specific PSA range, percent free PSA and presence of prostatic intraepithelial neoplasia or atypia are all considered to be relative indications for prostate biopsy. The current literature describes a trend toward increasing the number of cores obtained and the sites biopsied beyond those of the standard sextant technique. The additional cores in many series are obtained from more lateral regions of the gland. Conclusions: Although several criteria are used as indications for initial prostate biopsy, all are based on PSA level and/or abnormal digital rectal examination. Future improvements in currently used prostate cancer markers may result in better selection of cases to biopsy. There is no universally accepted technique of prostate gland biopsy. The current literature supports use of more extensive biopsy techniques to increase the likelihood of prostate cancer detection. References 1 : Prostate cancer detection in a clinical urological practice by ultrasonography. Digital rectal examination and prostate specific antigen. J Urol1990; 143: 1146. Link, Google Scholar 2 : Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med1991; 324: 1156. Crossref, Medline, Google Scholar 3 : Adenocarcinoma of the prostate. In: Campbell's Urology. Edited by . Philadelphia: W. B. Saunders Co.1992. Google Scholar 4 : Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA1993; 270: 860. Crossref, Medline, Google Scholar 5 : Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination. Urology1993; 42: 365. Crossref, Medline, Google Scholar 6 : Evaluation of the digital rectal examination as a screening test for prostate cancer. Rotterdam section of the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst1998; 90: 1817. Crossref, Medline, Google Scholar 7 : Prostate cancer detection at low prostate specific antigen. J Urol2000; 163: 806. Link, Google Scholar 8 : Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng./ml. or less. J Urol1999; 161: 835. Link, Google Scholar 9 : The significance of prostatic intra-epithelial neoplasia. Br J Urol1995; 76: 355. Crossref, Medline, Google Scholar 10 : Prostatic intraepithelial neoplasia: influence of clinical and pathological data on the detection of prostate cancer. J Urol1996; 156: 1050. Link, Google Scholar 11 : Strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia detected by prostate needle biopsy. J Urol1996; 155: 228. Link, Google Scholar 12 : Incidence of high-grade prostatic intraepithelial neoplasia in sextant needle bi