Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 26 • CUTTING EDGE - UROLOGY and GPC <5%) [64] at risk for clinically insignificant PCa. Highest diagnostic accuracy of clini- cally significant PCa in the re-evaluation of men in AS [65] is still, at present, obtained through extended or saturation prostate biopsy schemes combined with MRI/TRUS targeted biopsy. Finally, the transperineal approach reduces the incidence of sepsis (at most 0.07%) compared with 1–2% for the transrectal approach [11, 61, 66–74]. In conclusion, the transperineal approach could be recommended in persistent suspicion of PCa following one or more negative transrectal biopsies as this approach increases the detection of anterior PCa; furthermore, the transperineal route significantly reduces the incidence of sepsis in patients with previous prostatitis and/or recurrent urinary tract infection [75–77]. Sampling Sites and Number of Cores On baseline biopsies, the sample sites should be bilateral from apex to base as far as posteri- orly and laterally as possible in the peripheral gland (Videos 26.2, 26.3, 26.4, 26.5, and 26.6). Additional cores should be obtained from suspect areas by DRE/TRUS and MRI (Video). Sextant biopsy is no longer considered adequate. Ten to 12 core biopsies are recommended [78], with >12 cores not being significantly more conclusive [79, 80]. Transition Zone Biopsy Transition zone sampling during baseline biopsies has a low detection rate and should be confined to repeat biopsies [81]. Indications for Re-biopsy After a Previous Negative Biopsy Indications include (a) persistent increase in PSA, (b) suspicious DRE, (c) ASAP (atypical small acinar proliferation), and (d) extended PIN (prostatic intraepithelial neoplasia). The number of frustules taken must be higher than the first biopsy; you should also perform the transitional zone biopsy. Alternatively, the re-biopsy can be done by technical saturation (20–24 samples). Approximat ely, 20% re-biopsies ar e positive. Repeat Biopsy After Prev iously Negative Biopsy Isolated high-grade PIN in one or two biopsy sites is no longer an indication for repeat biopsy [82–85]. Cutting EDGE_Urology(SUN)_final.indd 26 27-Mar-18 10:00:30 AM