Optimizing prostate cancer diagnosis: 10-core versus 12-core prostate biopsy protocol

Abstract

Objective: To review the prostate cancer detection rate of a new 12-core prostate biopsy protocol.

Patients & Methods: From August and October 2011 onwards, 2 additional cores were added to the existing 10-core protocol during transrectal ultrasound-guided prostate biopsy (TRUS-Bx) in the diagnosis of early prostate cancer in Queen Mary and Tung Wah Hospitals respectively. Patient demographics, cancer detection rates and complications using the new 12-core protocol were retrieved from our prospective database and compared with those using the 10-core protocol.

Results: From January 2010 to March 2013, 626 and 631 patients underwent TRUS-Bx using a 10-core and 12-core protocol respectively. Overall for clinically benign prostates, there was a trend towards superior cancer detection using the 12-core protocol (5.3% vs. 7.2%, p = 0.077). Subgroup analysis showed the 12-core protocol had significantly higher cancer detection in patients with pre-biopsy PSA <10 ng/ml (OR 1.69; 95% CI 1.10–2.56; p = 0.019) and prostates sized 20–40 ml (OR 1.96; 95% CI 1.16–3.30; p = 0.014). There was a trend towards increased rate of septic complications after 12-core TRUS-Bx (1.9% vs. 3.1%; OR 1.68; 95% CI 0.95–2.97; p = 0.09).

Conclusion: 12-core TRUS-Bx can detect more prostate cancer in selected groups of patients, namely those with PSA <10 ng/ml and prostates sized 20–40 ml. Post-biopsy infection rate has increased with the new protocol marginally, owing to the increased number of cores.