Does it need to Take Digitally Targeted Biopsies Additionally to TRUS Guided 12- Core Systematic Prostate Biopsies? A Single Center Prospective Clinical Study

Purpose: To investigate whether digitally targeted additional biopsies enhance the detection rate of standard 12-core TRUS guided systematic biopsies. Methods: A total of 119 patients who either have a PSA level greater than 4ng/ml or suspicious DRE regardless of their PSA level underwent a twelve cores TRUS guided standard systematic prostate biopsies and two additional DRE guided targeted biopsies in case of abnormal DRE. The patients were divided into three groups with regards to their PSA level; Group I (n=8): PSA<4ng/ml, Group II (n=62): PSA 4-10ng/ml and Group III (n=49): PSA>10ng/ml. In each group, the independent diagnostic yield of DRE guided biopsies was compared to the standard systematic biopsies. The Results: Group I: In 3 out of 8 patients in this group were diagnosed as poorly differentiated prostate cancer. DRE guided biopsies detected one cancer out of 2 in this group. Group II: TRUSG guided systematic biopsies revealed 6 prostate cancer out of 7 cancer cases. DRE guided biopsies were also positive for prostate cancer in only 1 case, while standard 12-core systematic biopsies had failed to depict the cancer. Group III: Both TRUSG guided systematic biopsies and DRE guided biopsies revealed prostate cancer in all 17 cases. DRE guided biopsies did not increase the detection rate of systematic biopsies in this group. Conclusion: Digitally guided biopsies additionally taken to systematic 12-core biopsies do not enhance the detection rate of prostate cancer in the patients with a PSA level greater than 20ng/ml, possibly due to a large volume disease, however, it may be a useful adjunct for the patients with a PSA level less than 10ng/ml as well as in the presence of undifferentiated tumors.