AUA paper outlines optimal prostate biopsy practices

The AUA has released a new white paper providing recommendations for optimal prostate biopsy sampling, labeling, and processing.

According to the paper, which is based on a literature review of more than 500 articles, the use of 10- to 12-core extended-sampling protocols increases cancer detection rates compared to traditional sextant sampling methods and reduces the likelihood that patients will require a repeat biopsy by increasing negative predictive value.

The paper, accepted for publication in the Journal of Urology, follows on the heels of a large study presented at the recent Genitourinary Cancers Symposium in Orlando, FL, which also confirmed that cancer detection rates are enhanced when 10 to 12 specimens are obtained during biopsy.

The literature review had three objectives: to define the optimal number and location of biopsy cores during primary prostate biopsy among men with suspected prostate cancer; to define the optimal method of labeling prostate biopsy cores for pathologic processing; and to determine the maximal number of prostate biopsy cores allowable within a specimen jar that would not preclude accurate histologic evaluation of the tissue.

"A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoidance of a repeat biopsy, and adequate information for both identifying men who need therapy and planning that therapy while minimizing the detection of occult, indolent prostate cancers," wrote the authors, led by Samir S. Taneja, MD, of New York University’s Langone Medical Center, New York.

According to the authors, the literature review did not provide "compelling evidence that individual site-specific labeling of cores benefits clinical decision-making regarding the management of prostate cancer."

Regarding number of cores within a specimen jar, placement of more than two cores in a single container "appears to compromise pathologic evaluation," which can reduce cancer detection rates and increase the likelihood of equivocal diagnoses. Thus, the authors recommended packaging no more than two cores in each jar.