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Biopsy Core Density (Core Per Gram Ratio) Predicts Prostate Cancer Detection on Transrectal Ultrasound-Guided Prostate Biopsy.
Michael J. Schwartz, Andrew Hung, David Hwang, Jullet Han, Ming-Ming Lee, Justin W. McClain, M. Mendel Shemtov, Alexis E. Te, R. Ernest Sosa, E. Darracott Vaughan, Jr., Douglas S. Scherr
Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University
Introduction and objective: We reviewed all transrectal ultrasound (TRUS) guided prostate biopsies performed at our institution over the past 13 years to determine the optimal number of biopsy cores to take at the time of biopsy, controlling for prostate size.
Methods: A database of all TRUS guided prostate biopsies performed from August 1993 through December 2005 was compiled from a retrospective chart review. Patients with incomplete charts or prior intervention potentially affecting PSA were excluded. Patient age, PSA, digital rectal exam (DRE) findings, indication for biopsy, number of cores taken, prostate volume, and biopsy results were recorded. Positive predictive value was calculated for a range of biopsy core density (number of cores per gram of prostate tissue). Multivariate logistic regression models were also performed to evaluate the correlation of biopsy core density and positive biopsy rate.
Results: 3,634 prostate biopsies were performed at our institution over 13 years. Of these, 2,017 biopsies were performed that met criteria and with all parameters available at the time of this study. On multivariate logistic regression analysis, increases in biopsy core density predicted cancer detection better than increases age or PSA. For each increase of 0.1 in core density, there was a 1.45 fold increased risk of cancer findings on prostate biopsy (P ≤ 0.0001). A core per gram ratio between 0.6 and 0.7 maximized likelihood of finding cancer. However, the number of patients with higher core per gram ratios were too small to reliably demonstrate if higher cancer detection rates would be seen with a core density > 0.7. Biopsy core density tended to be lower in the early years or our study compared with more recent years, an expected finding considering an increase in the number of cores taken per biopsy session over time. Biopsy core density was inversely correlated with age (R = -0.941) and directly correlated with biopsy yield (R = 0.928).
Conclusions: Biopsy core density is a significant predictor of prostate cancer detection on TRUS guided biopsy, and is a better predictor than age or PSA. Given this finding, perhaps the number of biopsy cores taken should be determined by the size of the patient’s prostate rather than using a standard number of cores for all patients. The benefits of taking additional cores would have to be weighed against the risk of possible additional morbidity. Further evaluation in additional cohorts of patients is warranted to confirm these results.