The latter method involved taking biopsies from six sites: the apex, middle and base of each prostate lobe, parasagitally, in addition to any hypoechoic lesion seen on ultrasound. This sextant technique detected 9% more cancers compared with the former method. As a result of this there was a shift away from lesion-directed biopsies to a method of systematic sampling of the prostate using transrectal ultrasound to guide accurate needle placement. The Hodge protocol of systematic sextant biopsy of the prostate became the gold standard for many years in an era when an elevated PSA was an acceptable indication for prostate biopsy regardless of DRE findings
