Objectives: To evaluate the incidence of prostate cancer (PCa) in patients who underwent a saturation prostate biopsy (SPBx) as primary biopsy or in case of rebiopsy.
Methods: We assessed 189 patients (median age 60.3 years) submitted to a transrectal ultrasound-guided SPBx (range, 24 to 37 cores; median, 29). In 98 men the SPBx was performed as the primary procedure, in 75 as the second, and in 16 as the third biopsy set. Indications for biopsy were: abnormal DRE; total prostate specific antigen (PSA) (tPSA) greater than 10 ng/mL; tPSA equal to 4 to 10, 2.6 to 3.9, less than or equal to 2.5 ng/mL; and percent free PSA (%-fPSA) 25% or less, 20% or less, and 15% or less, respectively. The PCa detection using an SPBx as initial biopsy was compared retrospectively with that found in 256 and 116 patients who underwent 12- and 18-core biopsy, respectively, according to the same protocol. The results obtained in 75 patients submitted to an SPBx as the second biopsy set were compared retrospectively with those found in 73 men who underwent an 18-core re-biopsy.
Results: The PCa detection rate with SPBx as primary biopsy was 46.9%, greater than the 12-core biopsy (39.8%; P = 0.3) but lower than the 18-core biopsy (49%; P = 0.6). In the case of second and third biopsy, the incidence of PCa when using an SPBx compared with 18-core biopsy was 22% versus 10.9% (P = 0.003) and 6.2% versus 0%, respectively. The incidence of neoplastic microfoci was 34.7% at first and 45.5% at second biopsy set. In all patients who underwent a radical prostatectomy with a bioptic diagnosis of neoplastic microfocus, the pTNM revealed a clinically significant cancer (tumor volume greater than 0.5 mL or Gleason score of 6 or higher).
Conclusions: As primary biopsy, SPBx does not increase the PCa detection rate compared with an 18-core scheme; in the case of rebiopsy, the SPBx is a recommended method as the PCa detection rate is doubled compared with 12- or 18-core biopsy sets.