[Prostate biopsy: assessment of current indications and techniques]. / La biopsia prostatica: valutazione delle indicazioni e delle tecniche attuali.

ABSTRACT

Following pulmonary carcinoma, prostate cancer in the second leading cause of death due to neoplastic diseases and accounts for approximately 10% of all malignant neoplasms in the european male population. This disease is strictly and age related pathology and as such destined to be increasingly relevant in an ageing general population. The preventive measures and strategies being developed and refined are aimed at diagnosing tumours at an earlier stage and as a consequence increasing life. At this moment in time ultrasound (US) guided transrectal prostate sextant biopsies, described by Hodge as early as 1989, represent the most diffusely employed technique for the diagnosis of prostate cancer. Even if transrectal ultrasound (TRUS) markedly increases the US resolution capacity with respect to those obtainable transperineally or suprapubically, initial enthusiasm associated in performing biopsies of hypoechogenic zones for the diagnosis of early prostate cancers weaned after follow-up studies of this technique became available. Studies from different authors reveal how TRUS is inadequate in precisely pin-pointing prostate cancers above all early ones. According to the data published in the literature between 30 and 57% of hypoechogenic lesions discovered at US are not tumours but rather non-neoplastic prostatic tissue diseases such as acute or chronic infections/inflammations, atrophy, infarcts or prostatic intraepithelial neoplasms (PIN). Furthermore, Chang et al. have shown how sextant biopsies have a greater specificity in diagnosing prostate cancer with respect to single biopsies aimed at hypoechogenic areas, these values being 76 and 50% respectively. Having observed how many repeat prostate biopsies revealed the presence of a prostatic carcinoma following an initial negative prostate biopsy in patients with pre-existing elevated prostate specific antigen (PSA) levels has induced many authors to exceed the number samplings, as suggested by Hodge, performed during biopsies. Different diagnostic results obtained by biopsy sampling in different positions and in different numbers (up to a maximum of 18) have recently been compared in different studies. This concept follows the principle that increasing the number of samplings will invariably be associated by an increased diagnostic potential of prostate carcinomas, above all in those "grey zone" patients with PSA values less than 10 ng/ml, thus identifying the prostatic cancer at an earlier stage reducing morbility and correlated mortality, increasing specificity and reducing the quote of unnecessary biopsies.