Oncology Prostate Cancer overall cancer detection rate of 35.7%22 in the 140 patients biopsied,
rising to 47.6% of men with no previous biopsies. Of the 50 cancers detected, 23 patients (46%) underwent radical prostatectomy, of whom 20 (87%) had pathologically significant disease. Concordance between biopsy and whole-mount prostatectomy information showed concordance in 12 patients (52%), overestimated in two (9%) and underestimated in eight (35%), and biopsy Gleason score could not be assigned in one (4%). The insignificant cancer rate in this study was only 13%. No information on complications was reported.22
The advantages of the TargetScan would appear to be:
• improved intra- and inter-operator reproducibility of the biopsy technique;
• higher cancer detection rates; •
accurate mapping of prostate zones and biopsy site recording and storage;
1. 2. 3. 4. 5.
Wild JJ, Reid JM, Diagnostic use of ultrasound, Br J Phys Med, 1956;19(11):248–57.
Watanabe H, Kojima M, The role of prostatic planimetry using transrectal sonography in prostatic diseases, Semin Surg Oncol, 1997;13(6):425–30.
Rifkin MD, Sudakoff GS, Alexander AA, Prostate: techniques, results, and potential applications of color Doppler US scanning, Radiology, 1993;186(2):509–13.
Hodge KK, McNeal JE, Terris MK, Stamey TA, Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate, J Urol, 1989;142(1):71–4.
Eichler K, Hempel S, Wilby J, et al., Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review, J Urol, 2006;175(5): 1605–12.
6.
Pryor MB, Schellhammer PF, The pursuit of prostate cancer in patients with a rising prostate-specific antigen and multiple negative transrectal ultrasound-guided prostate biopsies, Clin Prostate Cancer, 2002;1(3):172–6.
7.
Borboroglu PG, Comer SW, Riffenburgh RH, Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies, J Urol, 2000;163(1):158–62.
8.
Stewart CS, Leibovich BC, Weaver AL, Lieber MM, Prostate cancer diagnosis using a saturation needle
9.
• •
better spatial cancer volume information; and precision guidance for focal therapy and brachytherapy.11,22,23 Conclusions
Sophisticated precision sampling and mapping techniques are technologies that are here to stay. Our ability to identify and accurately stage low-risk, low-volume cancers will improve and lead to more focal ablative treatment strategies and active surveillance. Reassuringly, patients with more aggressive disease suitable for radical curative therapy will be identified more easily. Further prospective randomised studies between transperineal template and transrectal 3D mapping techniques need to be performed to understand when each approach is most appropriate. Currently, in the transrectal approach the TargetScan biopsy system shows a similar cancer detection rate to the transperineal approach, possibly with less morbidity on initial studies. The technique may also prove more cost-effective as the procedure can be performed quickly under local anaesthesia in an outpatient setting.11
n
biopsy technique after previous negative sextant biopsies, J Urol, 2001;166(1):86–91.
Moran BJ, Braccioforte MH, Conterato DJ, Re-biopsy of the prostate using a stereotactic transperineal technique, J Urol, 2006;176(4 Pt 1):1376–81.
10. Bott SR, Henderson A, Halls JE, et al., Extensive transperineal template biopsies of prostate: modified technique and results, Urology, 2006;68(5):1037–41.
11. Delongchamps NB, Haas GP. Saturation biopsies for prostate cancer: current uses and future prospects, Nat Rev Urol, 2009;6(12):645–52.
12. Jones JS, Patel A, Schoenfield L, et al., Saturation technique does not improve cancer detection as an initial prostate biopsy strategy, J Urol, 2006;175(2):485–8.
13. Ficarra V, Novella G, Novara G, et al., The potential impact of prostate volume in the planning of optimal number of cores in the systematic transperineal prostate biopsy, Eur Urol, 2005;48(6):932–7.
14. Igel TC, Knight MK, Young PR, et al., Systematic transperineal ultrasound guided template biopsy of the prostate in patients at high risk, J Urol, 2001;165(5):1575–9.
15. Emiliozzi P, Corsetti A, Tassi B, et al., Best approach for prostate cancer detection, Urology, 2003;61(5):961–6.
16. Kawakami S, Yamamoto S, Numao N, et al., Direct comparison between transrectal and transperineal
extended prostate biopsy for the detection of cancer, Int J Urol, 2007;14(8):719–24.
17. Altug Tuncel, Yilmaz Aslan, Tezcan Sezgin, Omur Aydin, Umit Tekdogan, and Ali Atan. Does Disposable Needle Guide Minimize Infectious Complications After Transrectal Prostate Needle Biopsy? Urology 2008;71:1024–28.
18. Unpublished information supplied from Envisioneering Inc multicentre study database. No details recorded as to whether the patient followed the protocol or took their antibiotics.
19. Boccon-Gibod LM, de Longchamps NB, Toublanc M, et al., Prostate saturation biopsy in the reevaluation of microfocal prostate cancer, J Urol, 2006;176(3):961–3.
20. Epstein JI, Walsh PC, Carmichael M, et al., Pathologic and clinical findings to predict tumor extent of non-palpable (stage T1c) prostate cancer, JAMA, 1994;271(5):368–74.
21. Andriole GL, Bullock TL, Belani JS, et al., Is there a better way to biopsy the prostate? Prospects for a novel transrectal systematic biopsy approach, Urology, 2007;70(Suppl. 6):22–6.
22. Megwalu II, Ferguson GG, Wei JT, et al., Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer, BJU Int, 2008;102(5):546–50.
23. Taneja SS, Prostate biopsy: targeting cancer for detection and therapy, Rev Urol, 2006;8(4):173–82.
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