Gosselaar C.¹, Roobol M.¹, Roemeling S.¹, Wolters T.¹, Van Leenders A.², Schroder F.¹

Presented on March, 22 2007

INTRODUCTION & OBJECTIVES: The aim of this study was to determine the value of taking an extra hypoechogenic lesion-directed biopsy in addition to a systematic sextant biopsy for the detection of prostate cancer in the European Randomized study of Screening for Prostate Cancer (ERSPC), Rotterdam section.

MATERIAL & METHODS: Between May 1997 and May 2000, 10,754 men aged 55 to 75 years were invited for a PSA-determination. A PSA value =>3.0 prompted a transrectal ultrasound (TRUS)-guided lateralized sextant biopsy. In case of a hypoechogenic lesion, an additional lesion-directed biopsy was taken (7^th biopsy). The results of 1,849 biopsy sessions were evaluated.

RESULTS: In the 1,849 men biopsied, 541 PC cases were detected (29.3%). Four hundred forty-five of the 1,849 men (24.1%) had an abnormal TRUS result and had subsequently an additional 7^th biopsy. In these men 230 PC cases were detected (51.7%). In men who had a hypoechogenic lesion and a PC diagnosis, the 7^th biopsy core showed malignancy in 72.6% (167/230). In contrast, the mean percentage of being positive for malignancy was 46.7% in the randomly taken biopsy cores. In 3.5% (8/230) the lesion-directed biopsy core was the sole location showing malignancy. The PCs found on the basis of this additional biopsy (N=8) had all PC in 40% or more of the biopsy core, 5 had a Gleason score of 7 or higher and 3 showed clinically extraprostatic extension.

CONCLUSIONS: The performance of TRUS as a screening tool seemed poor. Although the additional biopsy was more often positive for cancer than the randomly taken cores of the sextant biopsy, the value of this 7^th core in addition to the systematic sextant biopsy seemed limited since only 3.5% of the visible cancers were detected solely by the 7^th biopsy. However a substantial part of these cancers were clinically relevant PCs that would have been missed without the additional biopsy. In men screened for the first time an additional biopsy in the case of hypoechogenic abnormalities is advisable. The value of an additional biopsy in pre-screened men is subject of current research and will be presented.

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