Tekrarlayan prostat biyopsilerinde ideal bir biyopsi şeması var mıdır? PCA3 PSA kadar faydalı mıdır?

  • Kaya Horasanlı
  • Mustafa Aydın

Bull Urooncol 2010;9(2):47-52

Prostate biopsy is the golden standard procedure for patients with prostate cancer doubt. Because of inadequate detection rate of sextant biopsy scheme of Hodge and the suggestive properties of new biopsy schemes about the morphology of cancer, extended or saturation biopsy concept had aroused. Anesthesia should be done prior to biopsy and the suggested method is to block of periprostatic nerves by using 1-2 % Lidocain. As there is no exact number of core or the sights, a number of 4 to 6 cores from apex, middle and basis is suggested. There is no need sampling from transitional zone in extended biopsy. Saturation biopsy described as taking more than twenty cores systematically. There is no superiority of saturation to extended biopsy as a first step. The patients with ongoing cancer suspect, asiner small atypical proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) in the first biopsy needs a second one. In such rebiopsy situations saturation biopsy highly recommended.

It is still controversial who should be biopsied for prostate cancer diagnosis. Because of low positive predictive values prostate specific antigen (PSA) and digital rectal examination (DRE) new laboratory tests are becoming as an issue. Prostate cancer gene 3 (PCA3) is a gene based protein expressed extensively in cancer tissue. Although PCA3 found superior in regard of for prediction of rebiopsy to PSA, there is still need for comprehensive trials before its routine clinical use.