The Incidence of Transition Zone Prostate Cancer Diagnosed by Transperineal Template-guided Mapping Biopsy: Implications for Treatment Planning

• Published in: Urology (Ridgewood, N.J.) N.J.), 2011-05, Vol.77 (5), p.1148-1152
• Main Authors: Patel, Vareel, Merrick, Gregory S, Allen, Zachariah A, Andreini, Hugo, Taubenslag, Walter, Singh, Satbir, Butler, Wayne M, Adamovich, Edward, Bittner, Nathan
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biopsy, Needle - methods; Gynecology. Andrology. Obstetrics; Humans; Incidence; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prostate - pathology; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - pathology; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2010.11.052

Objectives To report the incidence of transition zone (TZ) cancer in patients undergoing transperineal template-guided mapping biopsy (TTMB) of the prostate gland. Methods Five hundred thirty-nine consecutive patients underwent TTMB by means of an anatomic technique with sampling of 24 defined prostate regions. The position of each biopsy core was recorded in 3 dimensions. For every patient, the location of each positive biopsy core, the number of positive cores, the Gleason score, the percentage involvement of each core, and the presence/absence of perineural invasion was documented. Results The median volumetric prostate volume was 56.0 cm3 with an ellipsoid TZ volume of 20.1 cm3 . The median number of TTMB cores was 58 with a median of 11 TZ cores. Two hundred eighty-seven (53.2%) were diagnosed with prostate cancer. TZ cancer was detected in 130 (45.3%) of patients with prostate cancer but only 6 (4.6%) were confined to the TZ. Overall, 38.9% of TZ cores were positive for malignancy. Of the TZ cancers, 37 (28.5%), 64 (49.2%), and 29 (22.3%) were assigned Gleason scores 6, 7, and 8-10. Compared with a standard 12-core biopsy approach, the results of the TZ biopsy upgraded the Gleason score in 24.6% of patients. Only 4 cancers (3.1%) involving the TZ were classified as clinically insignificant. Conclusions Although only 4.6% of cancers were confined to the TZ, 45.3% of all prostate cancer patients had TZ involvement.