A review of transrectal ultrasound guided prostate biopsies: Is there still a role for finger guided prostate biopsies?

Abstract

Objective: We compared our institution's initial experience with transrectal ultrasound-guided (TRUS) prostate biopsies in a single arm prospective study to a historical cohort of finger guided (FG) biopsies. The primary outcome measure was prostate cancer detection. We documented our findings on TRUS including the findings of peripheral calcifications, hypoechoic lesions and capsular distortion and evaluated whether these had any significance in prostate cancer detection. Patients and methods: All patients presenting to our institution for prostate biopsy were included. Indications included raised PSA and/or abnormal DRE or other suspicion of prostate cancer. Data on 12-core TRUS guided biopsies were prospectively collected and compared to a historical cohort of 6-core FG biopsies obtained from the pathology database of all prostate biopsies performed at Groote Schuur Hospital within the study period. Results: One hundred and ninety-two patients were included in the TRUS group over a 25-month period (2008)(2009)(2010) and 262 FG biopsies were reviewed between 2006 and 2008. Abnormal DRE findings were present in 56.2% of FG and 43.3% of TRUS biopsies. Histology was available in 97.8% of cases. The incidence of prostate cancer was 42%. Malignant or suspicious histology was found in 45.6% of the FG group compared to 48.6% in the TRUS group (p = 0.27). In patients with a normal DRE there was a trend that favoured TRUS for improved cancer detection, which is significant if the PSA was below 10 ng/mL. Conclusion: Our study did not show superiority of TRUS over FG biopsies except when the patient had a low PSA (below 10 ng/mL) and a normal DRE. Systematic FG biopsies may be underutilised in the TRUS era, and may be of benefit in patients presenting with a PSA over 10 ng/mL or an abnormal DRE. This may be of value in a limited resource setting where access to TRUS is restricted.

Prostate cancer perspective: Africa versus the world

“…[36] It is interesting to note that a study in Cape Town, SA, found that TRUSguided prostate biopsy only outperformed finger-guided biopsies in terms of cancer detection when the PSA level was <20 ng/mL, which only became statistically significant when the PSA level was <10 ng/ mL, irrespective of the DRE findings. [37] The authors noted that, while far from the gold standard, finger-guided prostate biopsies remain a suitable alternative in resource-limited settings, especially when the prostate is clinically abnormal.…”

Comparative Prostate Cancer Detection Rate of Transrectal Ultrasonography Guided versus Finger Guided Prostate Biopsy

“…The 12 regions of the prostate were covered by the systematic biopsy, which was carried out by putting the needle following an in-house scheme (medial and lateral apex, medial and lateral mid prostate, and medial It is interesting to note that a newer study found that patients with suspicious DRE and PSA above 10 ng/ml do not have a statistically significant difference in cancer detection rates, with 45.6 and 48.6% for finger guidance and TRUS, respectively (P = 0.27) [6]. Fingerguided biopsies are still employed to diagnose PCa in some low-resource units when TRUS is unavailable and are indicated in the case of locally advanced disease or palpable prostatic nodules.…”

Hundred years of transperineal prostate biopsy

“…Their results demonstrated finding cancer in 53% of the time in patients with previously negative finger-guided biopsies ( n = 43) and confirming previously diagnosed cancer in 94% of subjects. 38 , 39 In the same year, Hodge et al published findings on systematic sampling. 39 – 41 In what would become known as the sextant technique, biopsy cores were taken from six regions of the prostate: apex, middle, and base of each lobe parasagitally in addition to any hypoechoic lesions identified on ultrasound.…”