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Diagnostic Performance of a Random Versus Lesion-Directed Biopsy of the Prostate From Transrectal Ultrasound

Results of a 5-Year Consecutive Clinical Study in 1 Institution in South Taiwan

Departments of Urology (S.-K.L.) and Radiology (Y.-H.L.), Buddhist Tzu-Chi Dalin General Hospital, Chia-Yi, Taiwan; and Department of Urology, College of Medicine, National Cheng Kung University Hospital and Douliou Branch, Tainan, Taiwan (Y.-S.T., T.-S.T.).

Address correspondence to Tzong-Shin Tzai, MD, Department of Urology, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan 70428, Taiwan. E-mail: tts777{at}mail.ncku.edu.tw

Objective. The purpose of this study was to compare cancer detection rates of sonographically suspicious lesion-directed biopsies and random biopsies through transverse examination of prostate halves in 518 patients over 5 years. Methods. From 1998 to 2002, 518 patients were referred for prostate biopsies because of either elevated prostate-specific antigen (PSA) levels or abnormal digital rectal examination findings. On the basis of transverse examination of prostate halves by transrectal ultrasound, we performed lesion-directed biopsy of 3 to 5 cores if morphologically suspicious lesions existed on sonography or random biopsy of 3 cores if no obvious suspicious lesions existed. Biopsy specimens were put into 2 labeled containers. Pathologic results were correlated with random and lesion-directed guided locations. Results. Nine-hundred fifty-nine results were obtained from 439 random and 520 lesion-directed biopsies in 518 patients. Cancer was detected in 207 patients (40.7%). Patients with cancer who had PSA levels of 10.0 ng/mL or greater had higher proportions of bilateral cancer lesions than those with PSA levels of less than 10 ng/mL (P = 0.03). One hundred ten (25.1%) of 439 normal-appearing halves taken by random biopsy were tumor-positive compared with 200 (38.5 %) of 520 biopsies from halves with sonographically suspicious lesions. Regardless of having random or lesion-directed biopsies, patients with PSA levels of 10 ng/mL or greater had higher positive malignancy rates than those with PSA levels of less than 10.0 ng/mL (P < .001). In about 40 patients, a diagnosis was made by random biopsy from halves that were morphologically normal on sonography, not by lesion-directed biopsy from tumor-suspicious contralateral halves. Conclusions. Cancer detection rates of lesion-directed biopsies are superior to those of random biopsies regardless of PSA level.

Key Words: biopsy • prostate • prostate cancer • ultrasound

Abbreviations: ANOVA, analysis of variance • DRE, digital rectal examination • PSA, prostate-specific antigen • TRUS, transrectal ultrasound