Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates

Objectives: To examine the ability of standard and saturation transrectal prostate biopsy techniques to predict appropriate candidates for active surveillance. Methods: Between 2005 and 2007, 500 consecutive patients underwent transrectal ultrasound-guided biopsy by a standard template (12 cores) or saturation template (≥18 cores, median 27 cores), with subsequent radical prostatectomy. Using the criteria of Gleason score ≤6, clinical stage T1 or T2a, prostate-specific antigen <10 and ≤33% of cores involved, 218 patients were potential candidates for active surveillance. Pathology results from the prostatectomy specimens were used to determine the accuracy of each biopsy technique. Biochemical failure after prostatectomy was evaluated using logistic and Cox proportional hazards regression. Results: A standard biopsy was carried out for 124 patients and saturation biopsy for 94 patients. There was no statistically significant difference between the groups in terms of median age (P=0.14), preoperative prostate-specific antigen (P=0.52) and clinical stage (P=0.23). Similar rates of Gleason score ≥7 at the time of radical prostatectomy were found, with 14% for standard biopsy and 15% for saturation biopsy (P=0.70). Upstaging was shown in two standard biopsy patients (1.6%) and no saturation biopsy patients (P=0.62). A multivariate analysis adjusting for prior prostate biopsy, preoperative prostate-specific antigen and clinical stage showed no difference in the rate of upgrading based on biopsy technique (P=0.26). During follow up, 5-year biochemical failure-free survival estimates were not significantly different (P=0.11). Conclusions: In men with prostate cancer, standard and saturation transrectal prostate biopsies techniques are equally predictive of candidates for active surveillance.