Journal Mobile Options
Table of Contents
Vol. 37, No. 1, 2000
Issue release date: January 2000
Eur Urol 2000;37:65–71

Comparative Study of Two Different TRUS–Guided Sextant Biopsy Techniques in Detecting Prostate Cancer in One Biopsy Session

Brössner C. · Madersbacher S. · Bayer G. · Pycha A. · Klingler H.C. · Maier U.
Departments of aUrology and bPathology, Oberwart Hospital, Oberwart; cDepartment of Urology, University of Vienna, and dDepartment of Urology, Danube Hospital, Vienna, Austria

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Objective: The aim of this study was to compare a transrectal ultrasound (TRUS)–guided sextant biopsy technique, which puts more emphasis on the apical region of the prostate where most prostate carcinomas (PCs) develop, with the standard sextant biopsy technique.

Methods: A total of 280 patients with suspected PC were included in this analysis. Twelve biopsy cores were obtained from all patients. Six biopsy cores were taken within a lateral parasagittal plane from each lobe at the apex, middle and basis, with an angle of approximately 45° (technique A), and 6 further biopsy cores were taken from the left to the right lateral margin always penetrating the prostate in the apex with the same angle (socalled fan–shaped technique, technique B). Technique A predominantly samples in the sagittal and technique B samples more in the transversal plane with emphasis on the apical region where most PCs develop. The sensitivity in detecting PCs for both techniques was calculated and correlated to the serum prostate–specific antigen (PSA) levels.

Results: A total of 72 PCs (25.7%) were diagnosed. We subsequently performed subgroup analysis depending on the serum PSA levels: in patients with a PSA of ≤10 ng/ml (n = 27) technique A has a PC sensitivity of 88.8% (p = 0.037) and technique B 96.2% (p = 0.326) as compared to our reference standard of 100% by sampling 12 biopsy cores in the same prostate. The number of positive biopsy cores using technique B was superior in 12 cases as compared to 3 cases with technique A (p = 0.04). In 12 patients the number of positive biopsy cores was identically. In patients with a PSA of >10 ng/ml (n = 45) technique A has a PC sensitivity of 93.3% (p = 0.083) and technique B 88.8% (p = 0.023) as compared to our reference standard. The number of positive core biopsies using technique A was superior in 14 cases as compared to 12 with technique B (p = 0.154). In 19 patients the number of positive biopsies was identical.

Conclusion: Our data suggest that in patients with PSA of ≤10 ng/ml technique B bring significant benefit with regard to the number of positive core biopsies, as well as an enhanced PC detection rate which is near the 12–core biopsy. Due to the fact that technique B samples more in the apical region where most cancers develop, it should be performed in suspected early stage cancers of the prostate (PSA≤10 ng/ml).

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Hammerer P, Huland H: Systematic sextant biopsies of 651 patients referred for prostate evaluation. J Urol 1994;151:99.
  2. Dyke CH, Toi A, Sweet JM: Value of random US–guided transrectal prostate biopsy. Radiology 1990;176:345.
  3. Billebaud T, Villers A, Astier L, Boccon Gibbod L, Darge MC, Sibert A, Baron JC, Delmas V: Advantage of systematic random ultrasound guided biopsies measurement of prostate specific antigen levels and determination of prostae volume in the early diagnosis of prostate cancer. Eur Urol 1992;21:6.
  4. Norberg M, Egevad L, Holmberg P, Sparen B, Norlen BJ, Busch C: The sextant protocol for ultrasound guided core biopsies of the prostate underestimates the presence of cancer. Urology 1997;50:562.
  5. Eskew LA, Bare RL, McCullough DL: Systematic five region prostate biopsy is superior to sextant biopsy for diagnosing carcinoma of the prostate. J Urol 1997;157:199–203.
  6. Stamey TA: Making the most out of six systematic sextant biopsies. Urology 1995;45:2.
  7. Hodge KK, McNeal JE, Terris MK, Stamey TA: Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989;142:71.
  8. Brössner C, Madersbacher S, Pycha A, Klingler HC, Kuber W, Marberger M: A comparative study of a double line versus a fan–shaped biopsy technique for obtaining transrectal ultrasound guided biopsies of the prostate. Eur Urol 1998;33:556–561.
  9. Albertsen PC, Fryback DG, Storer BE, Kolon TF, Fine J: Long term survival among men with conservatively treated localised prostate cancer. JAMA 1995;274:626.
  10. Aus G, Hugosson J, Norten L: Long term survival and mortality in prostate cancer treated with non curative intent. J Urol 1995;154:460.

    External Resources

  11. Häggman M: Localised prostatic cancer: A study of diagnosis, staging and prognostic factors. Acta Universitatis Upsaliensis, Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1993, vol 427.
  12. Borirakchanyavat S, Bhargava V, Shinohara K, Toke A, Caroll PR, Presti JC Jr: Systematic sextant biopsies in the prediction of extracapsular extension at radical prostatectomy. Urology 1997;50:373–378.
  13. Chen ME, Troncoso P, Johnston DA, Tang K, Babaian RJ: Optimisation of prostate biopsy strategy using computer based analysis. J Urol 1997;158:2168.
  14. Goto Y, Ohori M, Arakawa A, Kattan MW, Wheeler TM, Scardino PT: Distinguishing clinically important from unimportant prostate cancers before treatment: Value of systematic biopsies. J Urol 1996;156:1059–1063.
  15. Eskew LA, Bare RL, McCullough DL: Systematic five region prostate biopsy is superior to sextant biopsy for diagnosing carcinoma of the prostate. J Urol 1997;157:202.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50