Objective: To test the hypothesis that a combination of 6 posterior and 6 anterior cores detects more cancer than 12 posterior cores at a repeat transrectal prostate biopsy in men who have had one previous benign systematic biopsy. Patients and methods: Three hundred and forty men with persistently raised serum PSA were randomly allocated 1:1 to either a standard 12-core biopsy (12 cores from the lateral peripheral zone through a side-fire biopsy canal) or an experimental 12-core biopsy protocol with 6 anterior cores through an end-fire biopsy canal and 6 cores from the lateral peripheral zone through a side-fire biopsy canal. All biopsies were obtained transrectally with ultrasound guidance. The primary endpoint was cancer detection. Secondary endpoints were detection of ISUP Grade Groups/Gleason Grade Group ≥2 cancer, total biopsy cancer length and complications leading to medical intervention. Results: Prostate cancer was detected in 42/168 men (25%) in the experimental biopsy group and in 36/172 (21%) in the standard biopsy group (p = 0.44). The corresponding proportions for Gleason score ≥7 were 12% and 7% (p = 0.14). Median total cancer length was 4 (inter quartile range [IQR] = 1.5 - 6) mm in the end-fire group and 3 (IQR = 1.3 - 7) mm in the side-fire group. Ten men in the end-fire group and three in the side-fire group had a medical intervention for biopsy-related complications (p = 0.05). Conclusion: The biopsy protocol that included six end-fire anterior cores did not detect more cancer and was associated with more complications.

Scandinavian journal of urology. 2019 Jun 17 [Epub ahead of print]

Joakim Örtegren, Jan Tage Holmberg, Edvard Lekås, Sabah Mana, Stig Mårtensson, Jonas Richthoff, Pernilla Sundqvist, Henrik Kjölhede, Ola Bratt, Fredrik Liedberg

a Section of Urology, Department of Surgery , Växjö County Hospital , Växjö , Sweden., c Section of Urology, Department of Surgery , Ljungby Hospital , Ljungby , Sweden., d Department of Urology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden., b Department of Urology, Institute of Clinical Science, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden., f Department of Translational Medicine , Lund University , Malmö , Sweden.