BACKGROUND - Transperineal prostate biopsy (STPB) is associated with an improved cancer detection rate and an increase in anterior and apical prostate cancers compared to standard transrectal biopsy.
PATIENTS AND METHODS - A total of 48 men with at least two sets of prior prostate biopsies underwent transrectal ultrasound-guided STPB.
Prostate rebiopsy indications were serum prostate-specific antigen (PSA) levels greater than 2. 5 ng/mL and/or abnormal digital rectal examination and/or presence of high-grade prostatic intraepithelial neoplasia (HGPIN; ≥2 cores) or atypical small acinar proliferation (ASAP) at previous biopsies. The procedure was performed at dorsal lithotomy position under general anesthesia using a perineal 0. 5 cm brachytherapy template attached to the transrectal ultrasound probe. Specimens from each zone were sent separately for pathological examination.
RESULTS - Mean PSA level at STPB was 15. 9 ng/mL (range 4. 03 to 59. 57). An average of 54. 5 cores was obtained. Prostate adenocarcinoma was detected in 15 of 48 (31%) patients. Mean percentage of malignant cores was 11. 9%. Multivariate logistic regression analysis revealed that age and presence of ASAP or HGPIN at previous biopsies were independent predictors of prostate cancer (p<0. 05). No major complications, including sepsis and severe urinary or rectal bleeding, were observed in any of the patients. Five patients (10%) developed acute urinary retention after the procedure requiring urethral catheterization.
CONCLUSIONS - Considerable number of patients with negative multiple biopsies were diagnosed with prostate cancer. STPB is a well-tolerated procedure with minimal morbidity, which can be considered for the diagnosis of prostate cancer in patients with previous negative biopsies.
Urologia. 2015 Dec 30 [Epub ahead of print]
Sertac Yazici, Halil Kiziloz, Ali Cansu Bozaci, Dilek Ertoy Baydar, Dario Del Biondo, Haluk Ozen
Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey. , Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey. , Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey. , Department of Pathology, Hacettepe University School of Medicine, Ankara - Turkey. , Department of Urology, San Bassiano Hospital, Bassano del Grappa (Vicenza) - Italy. , Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey.