Prostate biopsy

All articles from this key word are listed below.

Numerous studies have cited the positive predictive value of isolated highgrade prostatic intraepithelial neoplasia (HGPIN) to the detection of cancer. Epidemiological, morphological, and molecular data support the potential for malignant transformation of HGPIN, yet no current method can discriminate which lesions will progress to clinically significant prostate cancer versus more latent lesions. Recent analyses of multiple retrospective studies have found similar rates of cancer detection following either diagnosis of isolated HGPIN or an initial negative biopsy. This may reflect increased use of extended biopsy techniques involving 10 or more cores rather than the true ability of HGPIN to undergo malignant transformation. This article discusses controversies surrounding management of an isolated diagnosis of HGPIN and whether repeat biopsy of HGPIN should be mandatory or selective in the context of other predictive values such as rising prostate-specific antigen or lesion on digital rectal examination. [Rev Urol. 2007;9(3):124-131]

Prostate cancer Prostate biopsy Repeat biopsy Prostatic intraepithelial neoplasia (PIN)High-grade PIN

Volume 9, Number 3 Review Articles

Prostate Biopsy: Current Status and Limitations

Diagnostic Update

Joseph C Presti

The technique of prostate biopsy has evolved over the past 10 years to improve our ability to detect prostate cancer. Extended biopsy schemes can be performed in the office under local anesthesia and are well tolerated. In addition to detection, the role of extended biopsy schemes in refining tumor grading and risk assessment has become better defined. This review discusses the evolution of prostate biopsy techniques from the sextant scheme to the extended scheme and demonstrates the latter's utility in clinical decision making. [Rev Urol. 2007;9(3):93-98]

Prostate cancer Prostate biopsy

Volume 14, Number 3 Meeting Reviews

Prostate Cancer Screening and Surgical Management of Localized Disease

Highlights From the 27th Annual Congress of the European Association of Urology

Stacy Loeb

Prostate-specific antigen Radical prostatectomy Prostate biopsy

Volume 15, Number 4 Original Research

Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

David G Bostwick Savvas E Mendrinos Deepak A Kapoor Carl A Olsson Ann E Anderson

This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in . 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%—this was identical at both the NRL and UPL (P 5 .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P 5 .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P 5 0.08). Positive biopsy rate correlated strongly (P , .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service. [Rev Urol. 2013;15(4):137-144 doi: 10.3909/riu0600] © 2014 MedReviews®, LLC

Prostate cancer Prostate biopsy Utilization trends National reference laboratory

Volume 15, Number 2 Meeting Reviews

Best of the 2013 AUA Annual Meeting

Highlights From the 2013 American Urological Association Meeting, May 4-8, 2013, San Diego, CA

Adam JM Kern

Prostate cancer PSA screening Nephrolithiasis Overactive bladder PCA3 Interstitial cystitis Prostate biopsy Transrectal ultrasound Erectile dysfunction Cystectomy Chronic pelvic pain syndrome Shock wave lithotripsy Prostate markers

Volume 18, Number 2 Review Articles

Reducing Infectious Complications Following Transrectal Ultrasound-guided Prostate Biopsy: A Systematic Review

Systematic Review

Claus G Roehrborn Jordon T Walker Nirmish Singla

A rise in antimicrobial resistant uropathogens has generated a global increase in infections following transrectal ultrasound-guided prostate biopsy (TRUS-Bx). We performed a systematic search of Ovid MEDLINE® and PubMed to comprehensively review strategies to mitigate infections. Of 1664 articles retrieved, 62 were included. The data suggest that augmented prophylaxis and povidone-iodine bowel preparation warrant consideration in regions with high rates of antimicrobial resistance. Transperineal biopsy may be a safer, equally effective alternative to TRUS-Bx in select cases. Recent international travel appears to increase patients’ risk for experiencing infections. These findings can aid clinicians in minimizing post-TRUS-Bx infectious complications. [Rev Urol. 2016;18(2):73-89 doi: 10.3909/riu0713] © 2016 MedReviews®, LLC

Urinary tract infection Prostate biopsy Transrectal ultrasound Systematic review

Volume 19, Number 1 Review Articles

Use of the 4Kscore Test to Predict the Risk of Aggressive Prostate Cancer Prior to Prostate Biopsy: Overall Cost Savings and Improved Quality of Care to the US Healthcare System

Health Economics

Stephen Zappala Jeffrey D Voigt Vincent Linder Yan Dong

The 4Kscore® Test (BioReference Laboratories, Elmwood Park, NJ) is a blood test that accurately determines the risk of aggressive prostate cancer and significantly reduces prostate biopsies and associated overdiagnosis and overtreatment of indolent cancer. A budget impact model was developed to test the hypothesis that the 4Kscore Test can improve quality of care and deliver cost savings for patients who are suspected of having prostate cancer and would otherwise undergo prostate biopsy under the current standard of care (SOC) in the United States. The direct costs (diagnosis plus treatment) utilized in the model are based on Medicare payment data and were calculated over a 1-year time horizon. The model compares SOC, in which all patients have prostate biopsy, to a “4Kscore strategy,” in which the 4Kscore Test is used to guide the decision to biopsy the prostate. A set of one-way sensitivity analyses was conducted to examine the robustness of the findings. Savings of more than $169 million (15.6% of total SOC costs) were realized in the 4Kscore strategy versus SOC ($917 M versus $1,086 M, respectively) in a cohort of 100,000 patients. Sensitivity analyses demonstrated that the findings are robust. Most cost savings for the 4Kscore strategy were realized in patients who, when managed by SOC, are found to have no prostate cancer or Gleason score 6 pathology. The patients with Gleason score 6 exhibited the greatest benefits from the 4Kscore strategy, avoiding both an unnecessary prostate biopsy and subsequent overtreatment. The 4Kscore Test was shown to significantly reduce costs to the healthcare system while improving patients’ quality of care. Providers and their patients suspected of having prostate cancer should consider using the 4Kscore Test prior to proceeding with prostate biopsy. [Rev Urol. 2017;19(1):1-10 doi: 10.3909/riu0753] © 2017 MedReviews®, LLC

Prostate cancer PSA screening 4Kscore Prostate biopsy Cost savings

Technique Review

Meeting Review

Point-Counterpoint

Diagnostic Update

Highlights From the 27th Annual Congress of the European Association of Urology

Highlights From the 2013 American Urological Association Meeting, May 4-8, 2013, San Diego, CA

Systematic Review

Health Economics

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