Comparison of prostate biopsy protocols using 3D computer simulation

To detect prostate cancer urologists routinely use the systematic sextant needle biopsy technique. This patterned biopsy technique has been adopted with little quantitative or scientific evidence to support its use. Using 136 digitized radical prostatectomy specimens, we developed 3D computer simulation software to compare the detection rate of cancer among various biopsy protocols. We further investigate the correlation between needle core tumor volume and total tumor volume. The 10- and 12- pattern biopsy protocols had a 98.5% detection rate, whereas, the sextant biopsy protocol was only 72.8%. The 5-region biopsy protocol had a 90.4% detection rate and the 14-pattern, which includes all the biopsies used in the patterns above only added one additional positive case (0.7%). All the patterns showed a significant correlation between core tumor volume and total tumor volume. Our results suggest that the 10-pattern biopsy protocol is statistically superior to the routinely used sextant prostate biopsy pattern.