A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer

Background: The aim of this study was to analyze the differences between TRUSguided transrectal prostate biopsy (TR) and transperineal prostate biopsy (TP) in the diagnosis of prostate cancer. The two biopsy methods were evaluated in terms of diagnostic sensitivity and of early and late complications. Methods: This retrospective study was realized through the review of clinical records of 219 men that received a prostate biopsy between 2004 and 2014. The biopsy was performed because of elevated prostate-specific antigen (PSA), abnormal digital rectal examination findings (DRE), abnormal transrectal ultrasound (TRUS) findings and symptoms due to prostate diseases. The cohort study was subdivided in two groups: 108 patients received a transrectal biopsy between 2004 and 2006 and 111 received a transperineal biopsy between 2007 and 2014. In both groups, first biopsy was performed with 12 cores scheme whereas second or third biopsy were performed with 18 cores scheme; in this study we excluded patients who underwent to biopsies with different number cores to reduce the bias. Both groups were evaluated on the basis of age, total PSA, PSA ratio (F/T), DRE/TRUS findings, presence/absence of low urinary tracts symptoms (LUTS), presence/absence of benign prostatic hyperplasia (BPH), histologic findings of biopsy cores and immediate/postoperative complications. Then, it was evaluated the overall cancer detection rate and the stratified cancer rate on the basis of the previous reported parameters. Finally, we analyzed the early and late complication rate in both groups. U Mann-Whitney test was used to evaluate the quantitative variables and χ<sup>2</sup>-test or Fisher exact test for qualitative variables. p < 0.05 was considered statistically significant. Results: 66 cancers were detected in 219 patients of the study; 29 cancers were detected in the TP group and 37 in the TR group. There were no statistically significant differences in the overall cancer rate detected in both groups (26.13% e 34.26% respectively; p = 0.190). However, TP biopsy detected more cancers at first biopsy than TR biopsy (89.7% vs 78.4% respectively; p = 0.021). Moreover, TP biopsy detected more cancers in those patients with low cancer suspect (PSA < 4 ng/ml, F/T > 15%, negative TRUS), instead TR biopsy had more sensitivity in detecting cancer in those patients with high cancer suspect (PSA > 10 ng/ml, F/T < 15%, TRUS with abnormal lesions). The presence of BPH did not influence sensitivity in both cases. There were no significant differences in the early complication rate whereas a statistically significant difference was observed in the late complication rate (4% vs 11% in TP and TR biopsy, respectively; p = 0.019). Conclusions: No statistically significant differences in sensitivity were observed between TP and TR biopsy, but TP biopsy detected more cancers at first time biopsy. Complications rate was lower in the TP group. Therefore, we conclude that the Urologist has the final choice in deciding the most appropriate biopsy technique, considering sensitivity and complications.

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COMPARISON BETWEEN TRANSRECTAL ULTRASONOGRAPHY GUIDED TRANSRECTAL PROSTATE BIOPSY AND TRANSRECTAL ULTRASONOGRAPHY GUIDED TRANSPERINEAL PROSTATE BIOPSY

Indonesian Journal of Urology ◽

10.32421/juri.v26i2.505 ◽

2019 ◽

Vol 26 (2) ◽

Author(s):

Randa Halfian ◽

Doddy M Soebadi ◽

Fikri Rizaldi

Keyword(s):

Prostate Cancer ◽

Rectal Bleeding ◽

Prostate Biopsy ◽

Pain Perception ◽

Prostate Tissue ◽

Transrectal Ultrasonography ◽

P Value ◽

Transperineal Prostate Biopsy ◽

Significant Difference ◽

Transrectal Prostate Biopsy

Objective: Prostate cancer is the fourth most common malignancy in men. TRUS guided transperineal prostate biopsy and TRUS guided transrectal prostate biopsy are two main approach to take prostate tissue as diagnostic of prostate cancer. To compare prostate biopsy approach between TRUS guided transrectal and TRUS guided transperineal toward duration of examination, pain perception, and complications. Material & Method: This study was an experimental study with prospective approach. There were two groups, group one was performed TRUS guided transrectal prostate biopsy (TRB) and group two was performed TRUS guided transperineal prostate biopsy (TPB). Evaluation was based on the duration of examination, pain perception, and complication. Data was analyzed using independent T test for duration of examination and Mann-Whitney test for pain perception. Data was performed using SPSS 21.0 version. The statistical significant difference was consider if p value <0.05. Results: There were 20 samples in this study. There was a significant difference in the duration of examination, the average duration of TPB examination (17.40 ± 2.50) was longer than the duration of TRB examination (14.1 ± 2.77). There was no significant statistical difference between TPB group and TRB group in pain perception when USG probe into the anal (p=0.65), anesthesia process (p=0.28), prostate tissue sampling (p=1.00), and post biopsy (p=0.34). Rectal bleeding was found mostly in TRB group (40%) compared to TPB group (0%). Hematuria was experienced by three patients (30%) in TRB group and two patients (20%) in TPB group. Conclusion: TRB was more effective in duration of biopsy than TPB. The complications of rectal bleeding and hematuria were more in TRB group than TPB. The pain perception were the same between both groups. There were no fever, sepsis, hematospermia and vasovagal event in two groups.

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Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of early prostate cancer among men who underwent Robotic transperineal prostate biopsy

10.21203/rs.2.12296/v1 ◽

2019 ◽

Author(s):

Du Jingzeng ◽

Ee Jean Lim ◽

Hong Hong Huang ◽

Weber Kam On Lau

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Predictive Value ◽

Full Blood Count ◽

Diagnostic Purpose ◽

Transperineal Prostate Biopsy ◽

Cancer Group ◽

Significant Difference ◽

Benign Histology ◽

Benign Group

Abstract Background： NLR is known to have prognostic value for metastatic prostate cancer. However for early-localized prostate cancer due to lack of systemic response; the role of NLR is not conclusive. In this study we aim to evaluate the predictive value of NLR for early clinical indolent prostate cancer in patients who underwent robotic transperineal prostate biopsy (RTPB). Methods: Patients who underwent RTPB under general anesthesia, at Urology Department, Singapore General Hospital between Sep 2006 and Feb 2016 were retrospectively reviewed. NLR was calculated for all patients using full blood count (FBC) that was done as pre-admission test before GA within 4 weeks before operation. And NLR values were compared between prostate cancer (PCa) and benign group. Results: A total 652 patients who underwent RTPB for diagnostic purpose with valid PSA level were included in this study. There were total 409 (62.7%) benign histology and 243 (37.3%) prostate cancer. There was no significant difference of median NLR between benign and prostate cancer group (2.00 vs. 1.99; P=0.29). In the subgroups analysis, there were also no significant difference of median NLR value in clinical significant cancer (defined as Gleason 3 + 4 and above) and benign histology group (NLR 2.00 vs. 2.01, P=0.41), as well as prostate cancer and benign group according to different pre-biopsy PSA levels: PSA (ug/l) < 4, 4-10,10-20 and > 20, respectively. (Median NLR 1.34 vs. 1.76; 1.97 vs. 1.97; 1.97 vs. 2.18; 2.18 vs. 1.98, P>0.05) Conclusion: There were no statistical significant difference of NLR between benign and prostate cancer group as a whole or in the subgroup analyses for patients who underwent robotic transperineal prostate biopsy. NLR may have a limited role in predicting early stage prostate cancer.

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Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of early prostate cancer among men who underwent Robotic transperineal prostate biopsy

10.21203/rs.2.23328/v1 ◽

2020 ◽

Author(s):

Du Jingzeng ◽

Ee Jean Lim ◽

Hong Hong Hong Huang ◽

Kam On Weber Kam On Lau

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Predictive Value ◽

Gleason Grade ◽

Early Prostate Cancer ◽

Transperineal Prostate Biopsy ◽

Cancer Group ◽

Significant Difference ◽

Benign Histology ◽

Benign Group

Abstract Background NLR is known to have prognostic value for metastatic prostate cancer (PCa). However for early PCa due to lack of systemic response; the role of NLR is not conclusive. In this study we aim to evaluate the predictive value of NLR for early clinical PCa in patients who underwent robotic transperineal prostate biopsy (RTPB). Methods Patients who underwent RTPB under general anesthesia (GA), at the Department of Urology, Singapore General Hospital between Sep 2006 and Feb 2016 were retrospectively reviewed. Exclusion criteria includes: 1. Patients with missing value of PSA NLR 2. Patients who underwent biopsy for non-diagnostic purposes. 3. Patients with chronic inflammation or high grade prostatic intraepithelial neoplasia. Patients who had more than one biopsies and only the last histology results were included in this study. NLR was calculated for all patients using Complete blood count that was done as pre-admission test before GA within 4 weeks before operation. NLR values were compared between PCa; clinical significant PCa and benign group. Patients were divided further into different groups according to PSA level for subgroup analysis. Results A total 652 patients who underwent RTPB for diagnostic purpose with valid pre-procedure PSA level were included in this study. There were total 409 (62.7%) benign histology and 243 (37.3%) PCa cases. Median NLR in the benign histology group and PCa group were 2.00 and 1.99. There was no statistically significant (P=0.29). In the subgroups analysis, there were also no significant difference of median NLR value in clinical significant cancer group (defined as Gleason 3 + 4 and above) when compared to benign group (NLR 2.00 vs. 2.01, P=0.41) as well as in prostate cancer group and benign group according to different pre-biopsy PSA levels (PSA < 4, 4-10, 10-20 and > 20 ug/L), respectively. (P>0.05). NLR is not a significant predictor for Gleason grade group and D’Amico risk stratification group. (P>0.05) Conclusion There were no statistical significant difference of NLR between benign and prostate cancer group as a whole or in the subgroup analyses for patients who underwent RTPB. NLR may have a limited role in predicting early prostate cancer.

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Whether Transperineal Prostate Biopsy Under Local-anaesthesia Using a Transperineal-access System is Non-inferior to Standard Transrectal Biopsy to Detect Prostate Cancer in Biopsy-naïve Men

Case Medical Research ◽

10.31525/ct1-nct04108871 ◽

2019 ◽

Author(s):

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Local Anaesthesia ◽

Access System ◽

Transperineal Prostate Biopsy ◽

Transrectal Biopsy ◽

Detect Prostate Cancer

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Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis

Oncotarget ◽

10.18632/oncotarget.15056 ◽

2017 ◽

Vol 8 (14) ◽

pp. 23322-23336 ◽

Cited By ~ 25

Author(s):

Jianxin Xue ◽

Zhiqiang Qin ◽

Hongzhou Cai ◽

Chuanjie Zhang ◽

Xiao Li ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Sequential Analysis ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

Transperineal Prostate Biopsy

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Detection Rate and Clinical Impact of PET/CT with 18F-FACBC in Patients with Biochemical Recurrence of Prostate Cancer: A Retrospective Bicentric Study

Biomedicines ◽

10.3390/biomedicines10010177 ◽

2022 ◽

Vol 10 (1) ◽

pp. 177

Author(s):

Luca Filippi ◽

Oreste Bagni ◽

Carmelo Crisafulli ◽

Ivan Cerio ◽

Gabriele Brunotti ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Management ◽

Biochemical Recurrence ◽

Detection Rate ◽

Major Change ◽

Emission Computed Tomography ◽

Prostate Bed ◽

Pet Ct ◽

Significant Difference ◽

Clinical Records

Our aim was to assess the detection rate (DR) of positron emission computed tomography (PET/CT) with anti-1-amino-3-[18F]-flurocyclobutane-1-carboxylic acid (18F-FACBC) in patients with biochemical recurrence (BCR) from prostate cancer (PC). As a secondary endpoint, we evaluated 18F-FACBC PET/CT’s impact on patients management. Clinical records of 81 patients submitted to 18F-FACBC PET/CT due to PC BCR in two Italian Nuclear Medicine Units were retrospectively assessed. DR was gauged in the whole cohort and stratifying patients by discrete intervals of PSA levels. PET/CT’s impact on clinical management was scored as (1) major if it entailed an intermodality change (e.g., from systemic to loco-regional therapy); (2) minor if it led to an intramodality change (e.g., modified radiotherapy field). PET/CT’s DR resulted in 76.9% in the whole cohort, with a positive predictive value of 96.7%. Stratified by PSA quartile intervals, PET/CT’s DR was 66.7%, 71.4%, 78.9% and 90% for PSA 0.2–0.57 ng/mL, 0.58–0.99 ng/mL, 1–1.5 ng/mL and >1.5 ng/mL without significant difference among groups (p = 0.81). The most common sites of relapse were prostate bed and pelvic lymph nodes (59.3%). PET/CT impacted on clinical management in 33/81 cases (40.7%), leading to a major change in 30 subjects (90.9%). 18F-FACBC PET/CT localized recurrence in patients with BCR, with meaningful DR also at low PSA levels and significantly impacted on clinical management.

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Clinical staging of prostate cancer: a computer-simulated study of transperineal prostate biopsy

BJU International ◽

10.1111/j.1464-410x.2005.05801.x ◽

2005 ◽

Vol 96 (7) ◽

pp. 999-1004 ◽

Cited By ~ 121

Author(s):

E. David Crawford ◽

Shandra S. Wilson ◽

Kathleen C. Torkko ◽

Daisaku Hirano ◽

J. Scott Stewart ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Clinical Staging ◽

Transperineal Prostate Biopsy

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Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI

Prostate Cancer ◽

10.1155/2020/4626781 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Maudy C. W. Gayet ◽

Anouk A. M. A. van der Aa ◽

Harrie P. Beerlage ◽

Bart Ph Schrier ◽

Maaike Gielens ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rates ◽

Prostate Biopsies ◽

Significant Difference ◽

Significant Pathology ◽

Study Population ◽

Clinically Significant ◽

Control Study

Objective. To compare prostate cancer detection rates (CDRs) and pathology results with targeted prostate biopsy (TB) and systematic prostate biopsy (SB) in biopsy-naive men. Methods. An in-patient control study of 82 men undergoing SB and subsequent TB in case of positive prostate MRI between 2015 and 2017 in the Jeroen Bosch Hospital, the Netherlands. Results. Prostate cancer (PCa) was detected in 54.9% with 70.7% agreement between TB and SB. Significant PCa (Gleason score ≥7) was detected in 24.4%. The CDR with TB and SB was 35.4% and 48.8%, respectively (p=0.052). The CDR of significant prostate cancer with TB and SB was both 20.7%. Clinically significant pathology upgrading occurred in 7.3% by adding TB to SB and 22.0% by adding SB to TB. Conclusions. There is no statistically significant difference between CDRs of SB and TB. Both SB and TB miss significant PCas. Moreover, pathology upgrading occurred more often by adding SB to TB than vice versa. This indicates that the omission of SB in this study population might not be justified.

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The eternal enigma in prostatic biopsy access route

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.3.245 ◽

2017 ◽

Vol 89 (3) ◽

pp. 245 ◽

Cited By ~ 2

Author(s):

Andrea Fabiani ◽

Emanuele Principi ◽

Alessandra Filosa ◽

Lucilla Servi

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Digital Rectal Examination ◽

Cancer Detection Rate ◽

Prostatic Biopsy ◽

Patient Age ◽

Rectal Examination ◽

Transperineal Prostate Biopsy

Dear Editors,We read with interest the article by Di Franco and co-workers (1). The introduction of prostatic magnetic resonance and the relative fusion-biopsy have not yet allowed the expected improvements in prostate biopsy. To our knowledge, there are no works that demonstrate the superiority of fusion techniques on the remaining ultrasound guided prostate biopsies that are still the widely used in the diagnosis of prostate cancer. Furthemore, these technologies are expensive exams and they are not yet available in all centers, especially in those minors. We work at a “minor” center and we always keep in mind that the goal of prostatic biopsy is the diagnosis and the staging of prostatic neoplasms.. However, it remains uncertain which of the two techniques, transperineal (TP) or transrectal (TR), is superior in terms of detection rate during first biopsy setting. Several studies have compared the prostate cancer detection rate but TR and TP access route in prostatic gland sampling seems to be equivalent in terms of efficiency and complications, as reported by Shen PF et al. (2), despite several methodological limitations recognized in their work. The results reported by Di Franco CA et al. represent the real life experience of most urologists that perform the PB based on their own training experience and available technical devices. From an historical viewpoint, the TP route has been the first one to be used to reach the prostate, both for diagnostic and therapeutic purposes. To date, because it seems to be more invasive and difficult, the TP route is less used worldwide than the TR one (2). Theoretically, the TP approach should detect more prostate cancer than the TR way because the cores of the TP approach are directed longitudinally to the peripheral zone and the anterior part of the prostate (4). The results reported by Di Franco et al. seems to confirm these considerations. However, our real life experience differ from the conclusions reached in their work. We recently conducted a prospective evaluation of 352 patients who underwent their first prostate biopsy because of a suspicious of prostate cancer (elevated prostate specific antigen (PSA) and/or abnormal digital rectal examination and/or abnormal findings on transrectal prostatic ultrasound). Patients was randomized as following. A total of 187 patients (Group A) underwent a prostatic biopsy with a transperineal approach in a lithotomic position, using a biplane probe (8818 BK Medical, Denmark) and a fan technique with a single perineal median access (5). The remnants 165 patients (Group B) underwent a transrectal ultrasound guided prostate biopsy in a left lateral position, using a end fire probe configuration (8818 BK Medical, Denmark) and a sagittal technique. The bioptic prostatic mapping was performed with a 12-core scheme sec. Gore (3) by a single experienced operator and the histopathologic evaluation was performed by a single dedicated uro-pathologist. Statistical evaluations were made with a T Student test (p<0,005). Group A and Group B was similar in term of mean patient age (67,9 years and 67 years respectively), mean total PSA (12,1 ng/ml vs 12 ng/ml) and digital rectal examination positivity (22% vs 29%). The global cancer detection rate was 33,69% (63/187) in the transperineal prostate biopsy group and 48,48 % (80/165) in the transrectal approach (p=0.0047). No significant statistical differences were found in the complications rates between the two groups. Statistical evaluation of site of tumor localization reveal only a trend to statistical significance in apical site tumors diagnosed with the TR approach versus the TP technique. The TR approach had a better diagnostic accuracy than TP technique in case of PSA<4 ng/ml, intermediate prostate volume (30 and 50 ml), normal digital rectal examination without any relationship with the patient age. In our experience, two aspect may explain the difference between the two group in term of global detection rate. First, we usually perform transrectal biopsy with a sagittal technique that simulates the transperineal way of needle incidence with the prostatic gland. The lateral and anterior gland portions may be sampled more accurately. Second, our transperineal approach consists in a single perineal median access that can make more difficult the gland sampling between the two lobes. However, there was no significant difference in core positivity rate at the peripheral zone, medium gland, apex or any other site such as reported in many randomized clinical trials (2). Unlike the conclusions reported by Di Franco et al., in our experience we found a statistically significant difference between the TR and TP approach, at the first biopsy setting, in term of global cancer detection rate. No differences were found in terms of complications. Moreover, our data suggest that TR approach had a better diagnostic accuracy than TP technique in case of PSA<4 ng/ml, prostate volume 30-50 ml, normal digital rectal examination without any relationship with the patient age. The further step of the statistical evaluation of our data will be the definition of the possibility that the TR biopsy determine a better staging of prostate cancer than TP approach as first procedure. REFERENCES 1) Di Franco CA, Jallous H., Porru D. et al. A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer Arch Ital Urol Androl 2017; 89(1), 55-92) Shen FP, Zhu YC, Wei WR et al. The results of transperineal vs transrectal prostate biopsy: a systematic review and meta-analysis. Asian Journal of Androl 2012; 14: 310-15.3) Gore JL., Shariat SF, Miles BJ., et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 2001; 165: 1554-59. 4) Abdollah F., Novara G., Briganti A. et al. Trasrectal versus transperineal saturation re biopsy of the prostate: is there a difference in cancer detection rate? Urology 2011; 77:9215) Novella G, Ficarra V, Galfano A, et al. Pain assessment after original transperineal prostate biopsy using a coaxial needle. Urology. 2003; 62 : 689-92.

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