Indications for transition zone biopsy in the detection of prostatic carcinoma

Purpose: We determined the indications for transition zone biopsy in the detection of prostatic carcinoma. Materials and Methods: A total of 185 men underwent 204 transition zone prostate biopsies due to elevated prostate specific antigen (PSA) alone in 19 (group 1), with hypoechoic transition zone lesions in 10 (group 2) and with a previous negative transrectal ultrasound guided biopsy in 156 (group 3). In addition, 13 men underwent 19 repeat transition zone biopsies. Results: Of the patients 58 (31.4%) had positive biopsies, with 8 (4.3%) having cancer in the transition zone biopsies only. In 3 men with positive peripheral and transition zone biopsies the cancer was upgraded based on the transition zone specimens. No patient with elevated PSA and no previous biopsy (group 1) or sonographic transition zone abnormalities (group 2) had a positive transition zone biopsy only. None of the analyzed risk factors (age, PSA, prostate volume, PSA density or PSA velocity) was significantly greater in men with isolated transition zone tumors. Conclusions: Routine transition zone biopsies should be reserved for patients with previously negative transrectal ultrasound guided biopsies. In some patients disease upgrading based on transition zone biopsies may influence treatment decisions.