A 12-year follow-up of ANNA/C-TRUS image-targeted biopsies in patients suspicious for prostate cancer

World J Urol. 2018 May;36(5):699-704. doi: 10.1007/s00345-017-2160-z. Epub 2017 Dec 23.


Purpose: PSA screening has been rehabilitated. PSA is not specific and can be elevated by benign reasons. Additionally, a subgroup of patients with prostate hyperplasia may harbor prostate cancer (PCa). During monitoring, the clinician aims to detect significant tumors in time, submitting patients to minimal psychological and physical burden, especially in men with high serum PSA and repeat biopsies. We aimed to determine long-term outcomes with respect to ANNA/C-TRUS ability to detect PCa with six targeted biopsies.

Methods: A subset of 71 patients were enrolled. During monitoring, they were subjected to primary, secondary, or even multiple prostate biopsies when needed. Protocol monitoring included PSA measurements, digital rectal examination (DRE) and imaging.

Results: The median follow-up was 12 years. Forty-one patients had a history of negative systematic random biopsies (1-3 sessions). Their age ranges 62-85 years, PSA 0.5-47.3 ng/ml, and the median prostate volume 11-255 cc. During monitoring, 15 patients were diagnosed with PCa. Only two harbored aggressive tumors. The median time to diagnosis was 6 years. All PCa patients are free from biochemical relapse. From the remaining 56 patients, 11 did not have any biopsies, 12 had one, 13 had two, and 20 had three or more biopsy sessions.

Conclusions: ANNA/C-TRUS is a useful method monitoring patients with a risk of PCa. 50-75% of the usually performed biopsy cores could be spared and, after 12 years, 97% of the patients were either without evidence of a PCa or were diagnosed with a good prognosis tumor.

Keywords: ANNA/C-TRUS; Prostate biopsy; Prostate cancer; Targeted biopsies; Transrectal ultrasound.

MeSH terms

  • Aftercare / methods
  • Aged
  • Aged, 80 and over
  • Digital Rectal Examination / methods
  • Humans
  • Image-Guided Biopsy / methods
  • Male
  • Monitoring, Physiologic / methods
  • Prognosis
  • Prostate* / diagnostic imaging
  • Prostate* / pathology
  • Prostate-Specific Antigen / analysis
  • Prostatic Neoplasms* / diagnosis
  • Prostatic Neoplasms* / pathology
  • Reproducibility of Results
  • Risk Assessment / methods


  • Prostate-Specific Antigen