TMTPB has reported advantages of more precise sampling of the entire prostate gland including the anterior and apical regions. These investigators sought to determine the detection rate and distribution of prostate cancer (CaP) in a group of men with previous negative TRUS biopsies. They studied 41 patients with a history of 1 or more previous negative biopsies who underwent TMTPB for primary indications of elevated PSA, elevated PSA velocity, and/or abnormal DRE. A transperineal approach permitted systematic prostate biopsy in 26 unique regions guided by a brachytherapy template. Prostate size determined total number of cores. Clinical and biopsy parameters were evaluated as predictors for presence and location of CaP.
The overall CaP detection rate was 53.7%. Significant CaP defined as Gleason score ≥7 was noted in 14 of 41 (34.1%) patients including 4/41 (9.8%) with high-grade disease defined as Gleason score ≥8. There was an average of 4.32 cores positive and 79.8% of positive cores were in the anterior zones vs. only 22.2% in the posterior zones (p<0.0001). They found the 13 positive cores for Gleason 8 or 9 cancers to be evenly distributed: anterior in 7 cores, posterior in 5 cores and periurethral in 1 core. Men had a mean of 2.78 (S.D. 1.46) prior biopsies before TMTPB and the number of prior biopsies was not associated with detection. On multivariate analysis for predictors of presence of CaP, only prostate volume was significant. Complications were limited to 8 patients (19.5%): urinary retention (3), hematuria (4) and atrial fibrillation with rapid ventricular rate (1) requiring admission.
Presented by Michael Rowley, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.