The prostate biopsy is the standard of care for the initial diagnosis of prostate cancer. This pertains to men with significant PSA changes and/or suspicious digital rectal examination. However, up to 30% of the performed transrectal ultrasound guided biopsies are negative despite a persistent rise in PSA.

 

There are many different types of prostate biopsies I have been completing in the office. Saturation biopsy are 18 or more biopsies of the prostate. The standard sextant biopsy, which is a 12 core biopsy (6 on each side of the prostate) is the most common type of biopsy. By doing more biopsies increases the cancer detection rate, little is known of the clinical significance.

 

The standard sextant biopsy regimen is reported to miss 15-35% of positive biopsies. This is partly due to the difficult to reach zones of the prostate. These include the anterior transition zone, superior and lateral to the urethra, inferior part of the anterior horn, and the midline of the peripheral zone.

 

In general, completing more that 18 biopsies is completed in the operating room.

 

In a man who has undergone multiple negative transrectal biopsies and has persistent high risks parameters, a transperineal biopsy is recommended. The transperineal biopsy has the advantage of uniform sampling of the whole prostate and better sampling of the transitional zone.