Comparing 10-Core versus 16-Core Biopsy Protocols in Repeat Prostate Biopsies: A Retrospective, Multivariable Analysis of 950 Veterans Open Access

Min, Jea Young (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/cf95jb57v?locale=en
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Abstract





Abstract

Comparing 10-Core versus 16-Core Biopsy Protocols in Repeat Prostate Biopsies:
A Retrospective, Multivariable Analysis of 950 Veterans
Patients with a high risk for prostate cancer and previously negative prostate biopsies are
often referred for repeat biopsy procedures. For initial biopsy, the current literature indicates
that extended sampling protocols with optimal peripheral zone targeting can increase the
likelihood of detecting cancer. However, there are relatively few studies that examine the
optimal number of cores for repeat biopsy procedures. In this retrospective study, we
analyzed 967 consecutive repeat biopsy procedures that used either 10-core or 16-core
biopsy protocols at the Atlanta Veterans Affairs Medical Center (VAMC). Descriptive
statistics were obtained from univariable analyses comparing the two protocols.
Multivariable models were built to compare the rates of cancer detection in the two
protocols and obtain odds ratios and corresponding 95% confidence intervals (CIs). A
separate multivariable analysis was performed only for subjects who had their initial biopsy
at the Atlanta VAMC, controlling for additional variables relating to the initial procedure.
Among subjects who had cancer, the disease characteristics were compared in the two
protocols. Overall, prostate cancer was detected in 418 subjects (43.2%), with 36.8% in the
10-core group and 45.7% in the 16-core group. The 16-core group was more likely to have a
positive biopsy compared to the 10-core group (OR=1.67, 95% CI 1.19-2.35) when
adjusting for potential confounders. In the analysis restricted to subjects who received their
initial biopsy at the VA the difference between the two groups was not statistically significant
although the point estimate was larger (OR=2.36, 95% CI 0.90-6.14). Having an 8-core
initial biopsy and having a high-grade prostatic intraepithelial neoplasia (HGPIN) on initial
biopsy were positively associated with cancer detection on repeat biopsy. The proportion of
patients with high grade or high volume cancer was not significantly different in the two
groups. In summary, we found that 16-core protocol was more likely to detect cancer
compared to the 10-core protocol. Patient-specific factors such as previous biopsy and
clinical characteristics should be considered when deciding the optimal number of cores for
repeat prostate biopsies.

Table of Contents

Table of Contents

Manuscript

Abstract..............................................1
Introduction.........................................2
Methods..............................................3
Results................................................6
Discussion............................................8
Conclusion...........................................12
References..........................................14
Tables.................................................17

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