Transperineal template‐guided saturation biopsy using a modified technique: outcome of 270 cases requiring repeat prostate biopsy

Abstract

Objectives• To determine the incidence of prostate cancer (PCa), and pathological grade and location of PCa, using a modified transperineal template-guided saturation biopsy (TTSB).• To compare the acute urinary retention (AUR) rate found using modified TTSB with that of published reports. Patients and Methods• A total of 270 consecutive patients with persistent clinical suspicion of PCa, despite a median (range) of 2 (1-6) sets of negative transrectal ultrasonography-guided biopsies, were enrolled and prospectively studied.• All underwent modified TTSB avoiding the peri-urethral area at the base of the prostate under general anaesthesia.• Statistical analysis was performed using binary logistic regression to determine the prebiopsy predictors of PCa and AUR. Results• The median (range) patient age was 64 (43-85) years, with a median (range) prostate-specific antigen (PSA) of 10 (1-114) ng/mL and median (range) prostate volume of 45 (17-106) mL. A mean (range) of 28 (16-43) cores were taken at modified TTSB.• Prostate cancer was diagnosed in 54.8% (Gleason scores 6 in 27.7%, 7 in 43.2%, 8-10 in 29.1% of patients).• The anterior third only was involved in 21%, the middle third in 6.8% and the posterior third in 8.7% of positive cases, although in 75% of positive cases there was some anterior involvement. Comparing uniquely anterior tumours with the 15.5% found uniquely in either the middle or posterior thirds, there was no significant difference between number of positive cores (2 vs 1, P = 0.091), maximum percentage core involvement (30 vs 17.5%, P = 0.315) and maximum tumour length (3.5 vs 2 mm, P = 0.092).• Fourteen patients (5.2%) developed AUR.• On multivariate analysis, PSA density (PSAD) and pre-TTSB PSA predicted PCa diagnosis, whilst prostate volume, prebiopsy PSA and PSAD predicted AUR. Conclusions• Modified TTSB has a high cancer yield, especially in the anterior region, in patients with previously negative histology but onward suspicion of PCa.• The modified TTSB technique provides a low risk of AUR without compromising cancer yield.

Comparison Between a Combined Transrectal and Transperineal Approach and a Transrectal Approach for Prostate Rebiopsy

“…There has been no general agreement regarding the number of cores and the optimal approach. In addition, we noticed that there was no specific relationship between the method used and the cancer detection rates (4,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) (Table IV).…”

Active Surveillance Following Modified Transperineal Template Guided Saturation Biopsy Demonstrates a Low Rate of Progression and Conversion to Radical Treatment, with Age and PSA Associated with Upgrading, Upstaging and Treatment

“…Our methodology and outcomes for TPSB have previously been described [16]. Patient reported experience also demonstrates that the procedure is well tolerated and caries acceptable postoperative symptom rates [17].…”

“…TPSB is reported to more accurately detect and characterise the extent and grade of PCa [16,19]. We, therefore, decided to offer this as an option to those considering AS after conventional TRUS biopsy.…”

“…TPSB provides reliable sampling to the entire prostate gland including the anterior/apical areas, when compared to conventional TRUS biopsy [16]. Thus, accurate tumour characterisation is more likely.…”

Current prostate biopsy procedures for in the detection of cancer

“…Значительное количество исследований посвящено изуче-нию роли трансперинеального доступа при повторных биопсиях ПЖ [19][20][21]. Сатурационная промежностная биопсия, по мне-нию многих авторов, обладает преимуществом при повторном исследовании, частота обнаружения РПЖ варьирует от 22,7 до 58% [20].…”