Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided prostate biopsies are not indicated

Purpose: Transrectal ultrasound guided biopsies of the transition zone and seminal vesicles have been useful in select patients. More widespread use of these additional biopsies has been proposed. The efficacy of routine transition zone and seminal vesicle biopsies was examined. Materials and Methods: From January 1988 to October 1994, 736 transrectal ultrasound guided systematic sextant biopsies were performed. From October 1994 to July 1995, 161 consecutive patients underwent transrectal ultrasound with systematic sextant, transition zone and seminal vesicle biopsies. Results: Of the 736 patients undergoing only sextant biopsies 309 (42.0%) had cancer and 24 (3.3%) required repeat biopsy, compared to 55 (34.2%) and 4 (2.5%) of 161 undergoing combined sextant, transition zone and seminal vesicle biopsies. Prostate cancer was found only in the systematic sextant biopsies in 43 of the former 55 patients (78.2%), and in the transition zone and systematic sextant biopsies in 11 (20.0%). One patient (1.8% of patients with cancer or 0.6% of all 161 patients) had cancer in only the anterior biopsies and 6 (10.9 and 3.7%, respectively) had cancer involving the seminal vesicles. Conclusions: Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided systematic sextant biopsies are not warranted.