INTRODUCTION: Reports of prostate cancer (PCa) detected from biopsies obtained from the transitional zone (TZ) have become more common. However, TZ prostate biopsies have the potential to cause infectious complications, and questions remain about their value. The purpose of the study was to investigate the detection of PCa from biopsies taken from the TZ and peripheral zone (PZ), individually and in combination.
METHODS: Retrospective data were collected from 482 men who underwent sextant PZ plus TZ biopsy (2 cores, 1 from each lobe) for suspected PCa. The data were analyzed for the relationships between the presence of PCa from TZ or PZ biopsies, prostate-specific antigen (PSA) levels, and Gleason scores (GSs).
RESULTS: PCa was detected on biopsy in 192 (39.8%) patients. PCa was detected only in the TZ for 10 patients (5.2%), only in the PZ for 69 patients (35.9%), and in both the TZ and PZ for 113 patients (58.9%). Obtaining a biopsy only from the TZ resulted in a significantly lower cancer detection rate than obtaining the biopsy only from the PZ or from the combined PZ and TZ (P < .05). High GSs (≥ 7) were found in 3 of 10 patients (30%) with PCa detected in the TZ, 29 of 69 patients (42%) with PCa detected in the PZ, and 90 of 113 patients (79.6%) with PCa detected in the combined TZ and PZ. Among the patients with PSA levels < 10 ng/mL, none of the 4 patients with PCa detected only in the TZ had GSs ≥ 7; however, 14 of 41 patients (34.1%) with PCa detected only in the PZ and 18 of 32 patients (56.3%) with PCa detected in the combined TZ and PZ had GSs ≥ 7. Patients with a biopsy only from the TZ had significantly fewer GSs ≥ 7 than patients with a biopsy only from the PZ or from the combined PZ and TZ in this PSA range(P < .05).
CONCLUSION: It may be possible to omit a prostate biopsy from the TZ for patients with serum PSA < 10 ng/mL.
KEYWORDS: Prostate biopsy; Transitional prostate zone; Gleason scores
CORRESPONDENCE: Katsumi Shigemura, MD, PhD, Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Japan 650-0017 ().
CITATION: UroToday Int J. 2010 Apr;3(2). doi:10.3834/uij.1944-5784.2010.04.05
ABBREVIATIONS AND ACRONYMS:GS, Gleason score; PBx, prostate biopsy; PCa, prostate cancer; PSA, prostate-specific antigen; PZ, peripheral zone; RP, radical prostatectomy; TRUS, transrectal ultrasound; TZ, transitional zone