OBJECTIVES: To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate.
PATIENTS AND METHODS: VTBC was established through partnership between urologists performing transperineal biopsies of the prostate (TPB) at three institutions in Melbourne. Consecutive patients who had TPB, as first biopsy or repeat biopsy following previous negative TRUS biopsy, between September 2009 and September 2013 in the VTBC database were included in this study. Data for each patient was collected prospectively (except for TPB prior to 2011 in one institution), based on the minimum dataset published by the Ginsburg Study Group Univariate and multivariate analyses were performed to identify factors predictive of cancer detection on TPB.
RESULTS: 160 patients were included in the study, of these 57 patients had TPB as first biopsy while 103 had TPB as repeat biopsy after previous negative TRUS biopsies The median patient age at TPB was 63, with the repeat biopsy patients having higher median serum PSA level (5.8ng/ml for first biopsy, and 9.6ng/ml for repeat biopsy) and larger prostate volumes (40cc for first biopsy, and 51cc for repeat biopsy) Cancer was detected in 53% of first biopsy patients and 36% of repeat biopsy patients, of which 87% and 81%, respectively, were clinically significant cancers, defined as Gleason score of 7 or higher, or more than 3 positive cores of Gleason 6 75% of cancers detected in repeat biopsies involved the anterior region (based on the Ginsburg Study Group's recommended biopsy map), while 25% were confined exclusively within the anterior region; a lower proportion of only 5% of cancer detected in first biopsies were confined exclusively within the anterior region Age, serum PSA level and prostate volume were predictive of cancer detection in repeat biopsies, while only age was predictive of cancer detection in first biopsies.
CONCLUSIONS: TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant cancer TPB provides excellent sampling of the anterior region of the prostate, which is often under-sampled using the TRUS approach, and should be considered an option for all men in whom a prostate biopsy is indicated.
Ong WL, Weerakoon M, Huang S, Paul E, Lawrentschuk N, Frydenberg M, Moon D, Murphy D, Grummet J. Are you the author?
Department of Urology, Alfred Health; Department of Epidemiology and Preventive Medicine, Monash University.
Reference: BJU Int. 2015 Jan 5. Epub ahead of print.