BlueCross BlueShield of Tennessee Medical Policy Manual

Saturation Biopsy for Diagnosis and Staging of Prostate Cancer


Prostate cancer is the second leading cause of cancer-related deaths in men in the United States.  The diagnosis of prostate cancer is made by biopsy of the prostate gland.  At present, many practitioners use a 12 to 14 core “extended” biopsy strategy for individuals undergoing initial biopsy. This extended biopsy is performed in an office setting and allows for more extensive sampling of the lateral peripheral zone; sampling of the lateral horn may increase the cancer detection rate by approximately 25%.

Another approach is the saturation biopsy, in which generally more than 20 cores are taken from the prostate in an effort to improve sampling of the anterior zones of the gland.  Saturation biopsy may be performed transrectally or using a transperineal approach. 




Studies showing improved initial detection of prostate cancer using saturation biopsy compared with the use of extended biopsies are inconclusive.  Few studies show improvement in clinical outcomes with the use of saturation biopsy as part of active surveillance.


American Urological Association. (2013). Early detection of prostate cancer: AUA guideline. Retrieved January 13, 2017 from

BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2016). Saturation biopsy for diagnosis, staging, and management of prostate cancer. (7.01.121). Retrieved January 13, 2017 from BlueWeb. (15 articles and/ or guidelines reviewed)

Jiang, X., Zhu, S., Feng, G., Zhang, Z., Li, C., Li, H., et al. (2013). Is an initial saturation prostate biopsy scheme better than an extended scheme for detection of prostate cancer? A systematic review and meta-analysis. European Urology, 63 (6), 1031-1039.  Abstract retrieved March 1, 2016 from PubMed database.

Li, Y. H., Elshafei, A., Hatem, A., Zippe, C. D., Fareed, K., Jones, J. S. (2014). Potential benefit of transrectal saturation prostate biopsy as an initial biopsy strategy: decreased likelihood of finding significant cancer on future biopsy. Urology, 83 (4), 714-8. Abstract retrieved from PubMed database November 10, 2014.

Li, Y.H., Elshafei, A., Li, J., Gong, M., Susan, L., Fareed, K, & Jones, J.S. (2014). Transrectal saturation technique may improve cancer detection as an initial prostate biopsy strategy in men with prostate-specific antigen <10 ng/ml. European Urology, 65 (6), 1178-1183. Abstract retrieved March 1, 2016 from PubMed database.

Maccagano, C., Gallina, A., Roscigno, M., Raber, M., Capitanio, U., Sacca, A., et al. (2012). Prostate saturation biopsy following a first negative biopsy: state of the art.  Urologia Internationalis, 89 (2), 126-35. Abstract retrieved from PubMed database November 10, 2014.

National Comprehensive Cancer Network. (2016, April). NCCN Clinical Practice Guidelines in Oncology (NCCN Guideline®). Prostate cancer early detection - V.2.2016. Retrieved January 13, 2017 from

Nelson, A., Harvey, R., Parker, R., Kaster, C., Doble, A., & Gnanapragasam, V. (2013). Repeat prostate biopsy strategies after initial negative biopsy: meta-regression comparing cancer detection of transperineal, transrectal saturation and MRI guided biopsy. PLOS One, 8 (2), e57480 (Level 2 evidence)

U.S. Preventive Services Task Force (USPSTF). Prostate cancer screening. Retrieved March 1, 2016 from




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