Does General Anesthesia and Extended Prostate Biopsies Enhance Prostate Cancer Detection Rate?

Objectives: Negative prostate biopsies results in extra-expenditures. We explored if prostate biopsies done under general anesthesia may facilitate higher number of samples and better gland evaluation with better sampling and targeting. Methods: 2,168 prostate biopsies (mean age: 59.2, SD:3.0) with at least 18 fragments undertaken under general anesthesia were studied. Narrow Prostate Specific Antigen (PSA) stratification, gland volume and number of fragments were analyzed according to presence of nodes and vascularity as for prostate cancer (CaP). p values were significant if <0.05. Results: Overall, CaP detection rate was 35.8%. Patients showed the same diagnostic rate on 1st (35.7%), 2nd (33.9%), 3rd (35.7%) – p > 0.05; with diminished probability for the 4th (18.2%) biopsy- p > 0.05. PSA < 4.0 showed similar rate of CaP detection - 32.4% X 35.6%; and number of CaP (+) cores - 3.9 X 4.6; in comparison to those with higher PSA. Suspected node on US increased the rate of CaP diagnosis (p = 0.001) but node was not specific for CaP. Vascularity of the node was not related to CaP detection. PSA > 4.0 is more relevant for low volume gland than for larger glands. Conclusions: Contrary to expectation use of general anesthesia did not improve the diagnostic detection rate for CaP on different sessions of biopsies except for small gland with PSA < 4 ng/dl where the detection rate improved with statistical significance.