Is transition zone biopsy valuable in benign prostatic hyperplasia patients with serum prostate-specific antigen >10 ng/ml and prior negative peripheral zone biopsy?

Abstract

OBJECTIVES:

To evaluate the importance of transition zone (TZ) biopsy in benign prostatic hyperplasia (BPH) patients with serum prostate-specific antigen (PSA) >10 ng/ml and prior negative peripheral zone (PZ) biopsy and to estimate the sensitivity of TZ biopsy.

MATERIAL AND METHODS:

A total of 273 BPH patients with PSA >10 ng/ml and prior negative PZ biopsy underwent an extended biopsy protocol. In patients with a TZ volume <25 cm(3), four TZ biopsies were taken (two cores per side from the apex and base). In patients with a TZ volume > or =25 cm(3) (n=183), six TZ biopsies were taken (three cores per side from the apex, middle and base). Overall, 215 patients were subjected to either transurethral resection of the prostate (n=162) or open enucleation of the adenoma (n=53).

RESULTS:

The extended biopsy revealed prostate cancers in 21.2% of cases (58/273). The zonal distribution of the positive cores was as follow: PZ cancers only in 67.2% of cases (39/58), TZ cancers only in 13.8% (8/58) and PZ+TZ cancers in 19% (11/58). Overall, 73.6% (14/19) and 36.8% (7/19) of TZ cancers were detected at the apex and middle of the TZ, respectively, while no TZ cancers at all were detected at the base (p=0.00015). The incidence of carcinoma on definitive pathology was 5.6% (12/215). Consequently, TZ biopsy detected only 61.3% (19/31) of TZ cancers. The incidence of pure TZ cancers was 7.3%. On the chi(2) test, patient age, serum PSA, transrectal ultrasonography findings and PSA density did not correlate significantly with the detection rate of TZ cancer. Prostate volume (p=0.023), TZ volume (p=0.027) and PSA/TZ density (p=0.007) were predictive of TZ cancers.

CONCLUSIONS:

Although TZ biopsy was the sole site of cancer in only 2.9% of cases (8/273), it improved the cancer detection rate by 14% in this selected group of patients. The majority (74%) of TZ cancers were detected at the apex site. TZ biopsy has a low sensitivity (61%).

• Authors: Mohamed Abdel-Khalek, Khaled Z Sheir, Mahmoud El-Baz, El-Houssieny Ibrahiem
• Journal: Scandinavian journal of urology and nephrology (Scand J Urol Nephrol) Vol. 39 Issue 1 Pg. 49-55 ( 2005) ISSN: 0036-5599 [Print] England
• PMID: 15764271 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• Prostate-Specific Antigen

Topics

• Aged
• Biomarkers, Tumor (blood)
• Biopsy
• Humans
• Incidence
• Male
• Prostate (pathology)
• Prostate-Specific Antigen (blood)
• Prostatic Hyperplasia (blood, pathology)
• Prostatic Neoplasms (diagnosis, epidemiology)
• Sensitivity and Specificity