Reassessing the diagnostic yield of saturation biopsy of the prostate

Objective: Prostate biopsy remains the gold standard for detection of prostate cancer (PCa). This study was performed to determine whether saturation biopsy (>= 24 cores) detects more prostate cancer than a standard 12-18 core office biopsy technique. Methods: We conducted a nonrandomized cohort study of a consecutive series of prostate biopsies. The primary outcome assessed by both univariate and multivariate analysis was the detection of PCa, whereas the secondary outcomes of HGPIN (high-grade prostatic intraepithelial neoplasia) and ASAP (atypical small acinar proliferation) were also analyzed. Results: From September 2005 to June 2006, a total of 469 patients undergoing prostate biopsy were included in this study. A standard office prostate biopsy was performed in 301 men, whereas 168 under-went a saturation biopsy. Age, body mass index (BMI), prostate volume, and family history of PCa were similar. However, patients in the saturation biopsy cohort were more likely to have had prior biopsies, higher pre-biopsy PSA, longer PSA doubling times, and to carry more frequent diagnoses of HGPIN or ASAP (all p < 0.05). After adjusting for covariates, saturation biopsy did not detect more abnormal pathology than standard office prostate biopsy, including PCa (OR, 1.2; p = 0.339), HGPIN (OR, 1.4; p = 0.368), or ASAP (OR, 2.2; p = 0.201). Conclusions: Saturation biopsy does not appear to detect more abnormal prostate pathology than standard office biopsy of the prostate. This procedure may be associated with increased cost and patient morbidity. (c) 2007 Published by Elsevier B.V. on behalf of European Association of Urology.