Improved Detection Rate of Prostate Cancer Using the 10-Core Biopsy Strategy in Singapore

To evaluate if changing the biopsy regime to 10 cores might improve the positive predictive value (PPV) of elevated prostate-specific antigen (PSA, elevated range, 4-20 ng/ml, normal range, < 4 ng/ml) for the diagnosis of prostate carcinoma. From February 2000 to April 2001, 191 patients, mean age 64 years (range, 38-85 yr), underwent transrectal ultrasound (TRUS) for either elevated PSA (elevated range, 4-20 ng/ml) and/or abnormal digital rectal examination (DRE). A 10-core TRUS-guided biopsy of the prostate was performed. This included the standard sextant biopsy and two additional cores for each far lateral zone. Using this technique, 47 out of 191 patients (24.6%) had prostate cancer. The PPV for PSA levels of 4.1 to 10.0 ng/ml and 10.1 to 20.0 ng/ml were 19.3% and 35.4%, respectively. The lateral cores contributed 21.3% of the cancer cases, which would have been missed if only sextant biopsies were performed. With the 10-core biopsy method, the PPV for prostate cancer for patients with a PSA in the range of 4 to 20 ng/ml was in the range of 25%. This is significantly different from previous reports. The reason for this may be due to the adoption of a better, more uniform and systematic biopsy strategy for patients with elevated PSA, or it may be a true reflection of the current population incidence. Hence, this biopsy strategy is highly recommended. ( Asian J Surg 2002;25(3):238-43)