Detection of high-grade prostatic intraepithelial neoplasia with the five-region biopsy technique

Objectives. To assess the ability of the five-region biopsy technique compared with the traditional sextant biopsy technique to detect high-grade prostatic intraepithelial neoplasia (PIN) in patients with an abnormal digital rectal examination or elevated prostate-specific antigen, or both, by a retrospective study. Methods. We conducted a retrospective review of 50 consecutive patients diagnosed with PIN at our institution from January 1990 to May 1998. Of the 50 patients, 26 patients were diagnosed with high-grade PIN. The reasons for the initial prostate biopsy were elevated prostate-specific antigen in 15 patients, abnormal digital rectal examination in 1 patient, and combined abnormalities in 10 patients. These patients underwent transrectal ultrasound-guided needle biopsy of the prostate using the five-region biopsy technique. Biopsy findings from regions 1, 3, and 5 (additional five-region biopsies) were compared with those of regions 2 and 4 (traditional sextant biopsies). Results. Of the 26 patients, PIN was detected in the sextant regions in only 14 patients (53%). However, by using the five-region biopsy technique, an additional 12 patients (47%) were diagnosed with PIN (P <0.05). Twenty-four patients underwent repeated five-region biopsies. Eight (53%) of the 24 patients were found to have prostate cancer. Of the eight patients with cancer, 5 of the cancers were found with the five-region biopsy technique. Conclusions. In this study, the five-region method of prostate biopsy significantly increased the diagnosis of PIN compared with the traditional sextant method of biopsy. Furthermore, 33% of patients diagnosed with high-grade PIN on the initial biopsies were found to have prostate cancer on subsequent five-region biopsies. UROLOGY 54: 853-856, 1999. (C) 1999, Elsevier Science Inc.