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Int J Clin Exp Pathol 2012;5(9):892-899

Original Article
Optimization of prostate cancer diagnosis by increasing the number of core biopsies
based on gland volume

Priya N Werahera, Kathryn Sullivan, Francisco G La Rosa, Fernando J Kim, M Scott Lucia, Colin O’Donnell, Rameshwar S Sidhu, Holly T
Sullivan, Beth Schulte, E David Crawford

Department of Pathology and Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA;
2Division of Urology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, Denver Health and
Hospital Administration, Denver, CO, USA; Department of Rheumatology, University of Colorado AMC Campus, Aurora, CO, USA; Department of
Radiation Oncology, University of Colorado AMC Campus, Aurora, CO, USA

Received July 16, 2012; Accepted September 3, 2012; Epub October 20, 2012; Published October 30, 2012

Abstract: In this prospective, non-randomized phase-I clinical trial, we comparatively studied the performance of six laterally-directed biopsies
or the modified fan-shaped biopsies (MFSB), midline sextant biopsies (MB), and transition zone biopsies (TZB) and examine their prostate
cancer (PCa) detection rates. A total of 114 patients received combinations of MFSB, MB, and TZB based on prostate gland volume: those
≤15cc received 8 biopsies; those >15cc but ≤ 50cc received 14 biopsies; and those >50cc received 20 biopsies. The mean prostate-specific
antigen (PSA) level, Gleason score, and prostate volume were 8.0 ng/ml, 6.4, and 47 cc, respectively. PCa detection rate of the MB was 25%
while the MFSB was 22%. The overall PCa detection rate was 33.3% with all biopsies. PCa and high-grade prostatic intraepithelial neoplasia
(HG-PIN) detection rates decrease as the size of the prostate increases. PCa detection rates were 50.0% for volumes ≤19.9cc and volumes of
>50cc had a detection rate of 25.8%. PSA levels of <3.0 had PCa detection rates of 15% which increased to 58% with PSA levels >9.0. In a
multivariate analysis, only TZB was significant for PCa diagnosed by PSA (β=7.4, p<0.01). Our study showed that it is important to perform both
the lateral MFSB and the MB to improve overall PCa detections rates. Thus, we recommend performing MB, MFSB, and TZB based on prostate
volume, as follows: 8 biopsies for ≤15 cc; 14 for those >15 cc but ≤50 cc, and 14-20 for those >50 cc. (IJCEP1207013).

Keywords: Prostate cancer, prostate gland volume, transrectal core biopsies, gleason score, PSA

Address all correspondence to:
Dr. Priya N Werahera
Department of Pathology, Mail Stop 8104
University of Colorado Denver Anschutz Medical Campus
P.O. Box 6511, Aurora, CO 80045, USA.
Tel: (303) 724-3784; Fax: (303) 724-3712
E-mail: Priya.Werahera@UCDenver.edu