Transrectal Saturation Technique May Improve Cancer Detection as an Initial Prostate Biopsy Strategy in Men with Prostate-specific Antigen <10 ng/ml

Background: Using transrectal saturation prostate biopsy (SPBx) as an initial strategy remains a controversial topic. Objective: To compare SPBx with extended prostate biopsy (EPBx) as an initial biopsy template in a large sequential cohort study. Design, setting, and participants: We reviewed 438 men with initial SPBx and 3338 men who underwent initial EPBx between January 2002 and October 2011. Intervention: Office-based SPBx under periprostatic local anesthesia. Outcome measurements and statistical analysis: The yield of SPBx was compared with EPBx. Multivariable logistic regression models addressed cancer detection (CD) and cancer characteristics. Results and limitations: Overall CD was 51.6% and 42.6% in men who underwent initial SPBx and EPBx, respectively. Multivariate analysis confirmed that SPBx was an independent predictor factor correlated with the CD (odds ratio [OR]: 1.66; 95% confidence interval [CI], 1.30-1.92). Stratified by prostate-specific antigen (PSA) values, CD was higher in SPBx compared with EPBx, 47.1% versus 32.8% (OR: 2.00; 95% CI, 1.19-3.38) in patients with a PSA < 4 ng/ml and 50.9% versus 42.9% in patients with a PSA from 4 ng/ml to 9.9 ng/ml (OR: 1.62; 95% CI, 1.20-2.20). By contrast, SPBx did not increase CD in men with a PSA > 10 ng/ml (60.0% vs 61%; OR: 1.42; 95% CI, 0.70-2.89). There was no significant difference in the detection of insignificant cancer (p = 0.223) or low-risk cancer (p = 0.077) between the two biopsy schemes. The limitation of our study is its retrospective nature and inhomogeneity. Conclusions: Compared with EPBx, SPBx significantly increases CD as an initial biopsy strategy in men with a PSA < 10 ng/ml without a significant increase in the detection of insignificant cancer. These findings suggest that SPBx may merit further investigation as an initial biopsy strategy in men with a PSA < 10 ng/ml in hopes of avoiding repeat biopsy for missed malignancy during the initial biopsy. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.