BERKELEY, CA (UroToday.com) - There has been renewed interest in transperineal prostate biopsy in recent years, but its optimal role in the evaluation of patients with elevated PSA is unclear.
Given the added cost and morbidity of the procedure compared with transrectal biopsy, we have employed the transperineal approach in a select group of patients with multiple prior negative biopsies. In this patient population, transperineal biopsy was associated with an overall cancer detection rate of 50%. Notably, 94.1% of these cancers were located in the anterior or apical regions of the gland, areas that are not adequately sampled by the transrectal approach. Several recent studies have reported similar results with transperineal biopsy,1-3 although the patients in these studies had fewer prior biopsies (mean 2.4 – 2.7) than our patient population (mean 3.7).
Collectively, these results indicate that a significant proportion of patients with persistently elevated PSA, despite prior negative biopsies, harbor clinically significant prostate cancer, and that the transperineal approach facilitates cancer detection by improved sampling of the anterior and apical regions of the gland.
References
- Dimmen M, Vlatkovic L, Hole KH et al. Transperineal prostate biopsy detects significant cancer in patients with elevated prostate-specific antigen (PSA) levels and previous negative transrectal biopsies. BJU Int 2011
- Mabjeesh NJ, Lidawi G, Chen J et al. High detection rate of significant prostate tumours in anterior zones using transperineal ultrasound-guided template saturation biopsy. BJU Int 2012
- Pal RP, Elmussareh M, Chanawani M et al. The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies. BJU Int 2012; 109: 367-371.
Written by:
Boris Gershman, MD and W. Scott McDougal, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
