Comparison of cancer detection between 18- and 12-core prostate biopsy in Asian patients with prostate-specific antigen levels of 4-20 ng/mL.

BACKGROUND: Although prostate biopsy is an accepted option for cancer detection, there is little data regarding the clinical outcome of 18-core transrectal ultrasound (TRUS)-guided biopsy. This retrospective study compared cancer detection rates and biopsy complications between 12- and 18-core TRUS biopsy in Asian patients with prostate-specific antigen (PSA) levels between 4.0 and 20.0 ng/mL.

METHODS: In total, 1120 consecutive patients with PSA levels between 4.0 and 20.0 ng/mL were divided into the 12-core (552 patients) and 18-core TRUS biopsy (568 patients) groups. The clinical outcomes of the 12- and 18-core TRUS-biopsy groups were compared. Clinical outcomes were evaluated by comparing the prostate cancer detection rates and post-biopsy complication rates.

RESULTS: There were no significant group differences in the PSA levels, but the mean age was significantly older in the 12-core biopsy group than in the 18-core biopsy group (mean age, 67.0 vs. 64.0 years, respectively; p = 0.001). The abnormal digital rectal examination rate was higher in the 12-core biopsy group than in the 18-core biopsy group (39.9% vs. 24.5%, respectively; p < 0.001). The prostate cancer detection rate was significantly higher in the 18-core group than in the 12-core group [adjusted odds ratio: 2.75, 95% confidence interval = 2.04-3.01; p < 0.001], especially in patients with age ≥ 50 years, PSA < 10 and cancer clinical stage cT1. (p < 0.001). Moreover, in patients with prostate volumes >30 mL or PSA densities <0.2, the prostate cancer detection rate was significantly higher in the 18-core group than in the 12-core group. There were no differences in the complication rates (e.g., urinary retention, hematuria, urinary tract infection, and urosepsis).

CONCLUSION: In Asian patients with serum PSA levels between 4.0 and 20.0 ng/mL, 18-core biopsy was associated with superior clinical outcomes to those of 12-core biopsy for detecting prostate cancer.