The role of the biopsy of the transitonal zone and of the seminal vesicles in the diagnosis and staging of prostate cancer

Objectives: To give an updated overview of the role of the transitional zone (TZ) biopsy and the seminal vesicle (SV) biopsy in the diagnosis and staging of prostate cancer. Methods: We review the literature dealing with the biopsy of the TZ and of the SVs. Recent published data concerning their respective impact on cancer detection and preoperative staging are discussed. Results: The role of TZ biopsy and of SV biopsy is controversial. While the benefit of TZ biopsy for cancer detection at the time of first biopsy seems to be of low value, many authors support its use in patients with prior negative biopsies and a persistently elevated Prostate Specific Antigen (PSA). An other indication for TZ biopsy may be the suspicion of prostate cancer in men with large prostate. For some authors, SV biopsy should be performed in patients with unfavorable clinical and/or biopsy features. For others, SV biopsy is not indicated, according to the fact that current normograms based on PSA, biopsy findings, and imaging can predict focal extraprostatic disease before any SV involvement, leading to consider these specific biopsies as unuseful. Indeed, at the time of focal extraprostatic disease, only finy focus of cancer in SV may be suspected which are obviously very difficult to detect using biopsy. Conclusions: Biopsy of the TZ may be offered for the diagnosis purpose in case of persistent suspicion of prostate cancer after a first negative set of sextant biopsies. Preoperative SV biopsy appears to be useless since biopsy features, in addition to PSA and radiology, provide a more accurate staging. (C) 2002 Elsevier Science B.V. All rights reserved.