Background. The aim of this study was to determine concordance rates for prostatectomy specimens and transrectal needle biopsy samples in various areas of the prostate in order to assess diagnostic accuracy of the transrectal biopsy approach, especially for presurgical detection of cancer in the prostatic apex. Materials and Methods. From 2006 to 2011, 158 patients whose radical prostatectomy specimens had been evaluated were retrospectively enrolled in this study. Concordance rates for histopathology results of prostatectomy specimens and needle biopsy samples were evaluated in 8 prostatic sections (apex, middle, base, and transitional zones bilaterally) from 73 patients diagnosed at this institution, besides factors for detecting apex cancer in total 118 true positive and false negative apex cancers. Results. Prostate cancer was found most frequently (85%) in the apex of all patients. Of 584 histopathology sections, 153 (49%) from all areas were false negatives, as were 45% of apex biopsy samples. No readily available preoperative factors for detecting apex cancer were identified. Conclusions. In Japanese patients, the most frequent location of prostate cancer is in the apex. There is a high false negative rate for transrectal biopsy samples. To improve the detection rate, transperitoneal biopsy or more accurate imaging technology is needed. 1. Introduction One of the most frequent location of cancer in the prostate gland is in the apex. Iremashvili et al. showed the incidence of carcinoma in prostatectomy specimens; 65.4% of all patients had apex carcinoma, 56.6% had middle carcinoma, 47.3% had base carcinoma [1]. Apex core specimens obtained by needle biopsy have been associated with the highest cancer detection rates [2]. However, to the best of our knowledge, there have been no previous reports of assessments of the sensitivity and specificity of transrectal biopsy procedures for detection of apical prostate cancer through determining correlations between histopathologic diagnoses of preoperative transrectal biopsy and subsequently resected tissue specimens, especially with regard to presurgical detection of prostate cancer localized to the apex. Recently, in Japan, prostate cancer (PCA) screening has spread and diagnostic imaging technology has improved. Detection of early stage PCA has been increasing [3, 4]. Kikuchi et al. reported that, in the United States after 1995, many smaller PCAs detected were located in the apex of the prostate: the frequency of apical cancer detection after 1995 had risen to 46% from 26%, a significant increase [5,
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