Transperineal biopsy under ultrasound guidance for prostate cancer detection as an initial and as a repeat biopsy strategy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present the authors' experience on transperineal prostate sector biopsy (TPSB) in detecting prostate cancer, in identifying both low Gleason prostate cancers as well as clinically significant prostate cancer (Gleason 7 and higher), and in determining anatomical distributions of prostate cancer in both initial and repeat biopsy settings.<br /><strong>METHODS:</strong> All patients from June 2014 to September 2016 who underwent TPSB, as initial biopsy or repeat biopsy after previous negative transrectal ultrasound-guided biopsy (TRUSPNB) were included. Data for each patient were collected prospectively and subjected to statistical analysis. T test was used for continuous variables while Chi square test or Fisher exact test was used for categorical variables. Multiple logistic regression models were used to identify factors predictive of a positive result.<br /><strong>RESULTS:</strong> A total 130 patients were included in the study, 73 had TPSB as initial biopsy and 57 as repeat biopsy after previous negative TRUSPNB. The mean patient age of the Initial Biopsy Group (IBG) was 66 years while the mean age for the Repeat Biopsy Group (RBG) was 68 years. The IBG had a lower mean serum PSA level (9.07 ng/mL for IBG and 9.59ng/mL for RBG) and smaller prostate volumes (42.9 mL for the IBG and 44.3mL for the RBG). Prostate cancer was detected in 65.8% (48/73) of the IBG and 40.4% (23/57) of RBG, of which 77.1% (37/48) and 73.9% (17/23) respectively, were clinically significant, defined as a Gleason score of ?7. Of the cancers detected in IBG, 29.2% (14/48) exclusively involved the anterior sector (based on the Ginsburg Study Group's biopsy map), while 30.4% (7/23) were conned exclusively within the anterior sector for the RBG. Increasing PSA level and lower prostate volumes were predictive of cancer detection in RBG, while only increasing PSA level was predictive of a positive result in IBG.<br /><strong>CONCLUSION: </strong>Transperineal prostate sector biopsy demonstrated a high prostate cancer detection rate for both the initial and repeat biopsy settings. Likewise it provides for excellent sampling of the anterior region of the prostate, as it affords a more accurate sampling of the prostate gland based on a preplanned map and template to sample areas of interests. Similarly, it detects a high proportion of patients with clinically significant prostate cancer. This technique should therefore be highly considered as a first line option for all patients in whom a prostate biopsy is warranted.</p>

Transperineal biopsy under ultrasound guidance for prostate cancer detection as an initial and as a repeat biopsy strategy

OBJECTIVE: To present the authors' experience on transperineal prostate sector biopsy (TPSB) in detecting prostate cancer, in identifying both low Gleason prostate cancers as well as clinically significant prostate cancer (Gleason 7 and higher), and in determining anatomical distributions of prostate cancer in both initial and repeat biopsy settings.METHODS: All patients from June 2014 to September 2016 who underwent TPSB, as initial biopsy or repeat biopsy after previous negative transrectal ultrasound-guided biopsy (TRUSPNB) were included. Data for each patient were collected prospectively and subjected to statistical analysis. T test was used for continuous variables while Chi square test or Fisher exact test was used for categorical variables. Multiple logistic regression models were used to identify factors predictive of a positive result.RESULTS: A total 130 patients were included in the study, 73 had TPSB as initial biopsy and 57 as repeat biopsy after previous negative TRUSPNB. The mean patient age of the Initial Biopsy Group (IBG) was 66 years while the mean age for the Repeat Biopsy Group (RBG) was 68 years. The IBG had a lower mean serum PSA level (9.07 ng/mL for IBG and 9.59ng/mL for RBG) and smaller prostate volumes (42.9 mL for the IBG and 44.3mL for the RBG). Prostate cancer was detected in 65.8% (48/73) of the IBG and 40.4% (23/57) of RBG, of which 77.1% (37/48) and 73.9% (17/23) respectively, were clinically significant, defined as a Gleason score of ?7. Of the cancers detected in IBG, 29.2% (14/48) exclusively involved the anterior sector (based on the Ginsburg Study Group's biopsy map), while 30.4% (7/23) were conned exclusively within the anterior sector for the RBG. Increasing PSA level and lower prostate volumes were predictive of cancer detection in RBG, while only increasing PSA level was predictive of a positive result in IBG.CONCLUSION: Transperineal prostate sector biopsy demonstrated a high prostate cancer detection rate for both the initial and repeat biopsy settings. Likewise it provides for excellent sampling of the anterior region of the prostate, as it affords a more accurate sampling of the prostate gland based on a preplanned map and template to sample areas of interests. Similarly, it detects a high proportion of patients with clinically significant prostate cancer. This technique should therefore be highly considered as a first line option for all patients in whom a prostate biopsy is warranted.

Prostate Cancer Detection by Transrectal Ultrasound Guided Prostate Biopsy: Urology versus Radiology at a Single Academic Institution / 대한남성과학회지

PURPOSE: Many centers rely on radiologists to detect prostate cancer by transrectal ultrasound guided prostate biopsy. In this study we evaluated transrectal ultrasound guided prostate biopsy by radiologist or urologist, and compared prostate cancer detection rate, pathologic results and pain scrore. MATERIAL AND METHODS: In all, 259 consecutive patients had transrectal ultrasound guided prostate biopsy by one radiologist (group 1) and one urologist (group 2). The indication for prostate biopsies were a raised or rising prostate specific antigen (PSA) level or abnormal digital rectal examination (DRE). All data were collected prospectively. RESULTS: Both group showed comparable demographic data in age, PSA, prostate volume. But pain score showed higher in urologist group (p10 ng/ml. Both groups had similar Gleason score (6.8+/-0.7 vs 6.7+/-0.8) and number of cancer cores (3.0+/-1.7 vs 3.9+/-2.3). Group 1 showed significantly low visual analogue pain scale compared with Group 2 (2.9+/-1.9 vs 4.0+/-2.1)(p<0.05). CONCLUSION: Transrectal ultrasound guided prostate biopsy showed equally reliable datas whether performed by radiologist or urologist. The urologist can effectively perform transrectal ultrasound guided prostate biopsy like radiologist in detecting prostate cancer. Also we recommend to perform anesthesia to relieve pain before prostate biopsy and furthermore future studies with more patients with more datas are needed.

Prostate Cancer Detection Rate According to Prostate Volume and Age With PSA Levels of above 4.0ng/ml / 대한남성과학회지

PURPOSE: We retrospectively investigated the changes of prostate cancer detection rate according to patients prostate volume, age with prostate-specific antigen (PSA) levels of above 4.0ng/ml. MATERIAL AND METHODS: Data were collected from 663 patients who underwent 10 core prostate biopsy for elevated PSA above 4.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. Prostate cancer detection rate was calculated according to prostate volume (less than 40 vs 40 or more 40ml) and age (less than 60, 60-69, 70-79, 80 or more years old). Also we compared prostate cancer detection rate according to PSA levels (4-10 vs 10-20ng/ml). RESULTS: Among the 663 patients who underwent prostate biopsy, prostate cancer was detected in 134 patients (20.2%). There were no stastically difference in mean age, mean prostate volume, and mean PSAD except mean PSA (13.9 vs 11.9ng/ml) between cancer and non-cancer groups. The cancer detection rate in small prostate was significantly higher than large prostate (23.5% vs 16.0%). The cancer detection rate was significantly increased with age: from 14.5% for below 60 year-old patients to 30.3% for the 80 or more year-old patients. There was no significant difference in cancer detection rate between the two PSA groups (19.0 vs 20.5%). CONCLUSION: Prostate cancer detection rate was higher in old patients and patients with small prostate volume. The older age group and the patients with small prostate volume was considered as the important factors to decide whether biopsy of prostate is needed.

Technical refinements of transrectal ultrasound-guided prostate biopsy in prostate cancer detection

Rationale: In the Philippine setting, prostate cancer detection using sextant biopsy techniques yielded result ranging from 6-10 percent. However, with the introduction of the 12 core systematic biopsy technique, the cancer detection increased to 23 percent. The yield is still inferior compared to foreign counterpart and a deeper reassessment of the biopsy technique may prove otherwiseObjective: This study aims to evaluate cancer detection using a technical refinement wherein an ultrasound machine is used to visualize the prostate gland both in sagittal and longitudinal views, directing the biopsies more laterally to better sample regions of the peripheral zone using the marker lineMethods: This is a prospective cohort study of 68 consecutive males who underwent prostate biopsy from two tertiary hospitals performed by one consultant from January to September 2004. The indications for prostate biopsy included an elevation of serum PSA and/or an abnormal digital rectal examination. However, due to higher likelihood of prostate cancer in men with higher PSA, patients with PSA above 20 ng/ml were excluded from this study. The ultrasound machine used in Group A was ACUSON while that in group B used Bruel Kjaer 5001. All patients underwent a systematic 12 core biopsy techniqueResults: A total of 68 male patients with a mean age of 66.11 +/- 8.09 years, who underwent transrectal ultrasound guided prostate biopsy using the twelve core protocol from January to September 2004 were included. Twenty-eight (28) patients were included in group A and 40 were in group B. The pre-biopsy PSA level taken showed a mean of 9.55 +/- 3.03. The mean prostate gland volume on transrectal ultrasound was 39.67 +/- 13.6 and 39.67 +/- 16.9 for group A and B, respectively. The overall cancer detection rate from the total study population was 41.3 percent. Detection rate of the two populations were compared using the Wilcoxon Signed Rank Test and the Mc Nemars Test. The detection rate for group A was 21 percent while the detection rate for group B using the technical modification was 50 percent. There was a significant difference in cancer detection between the two populations at z= 2.53, p=0.01 using Wilcoxon Signed Rank Test and at p=0.02 in Mc Nemars test. Reliability analysis was also done to determine differences in the detection rates of the tests done in the two different institutions. Friedmans chi square, x2 was 14.8 at p=0.002, which means that the detection rates between the two institution was significantly differentConclusion: The prostate biopsy technique of using biplanar transrectal probe that allows confirmation of the needle tract in the transverse view before doing the biopsy in the sagittal view of the prostate increased the yield of prostate cancer detection to 50 percent. The conventional 12 core biopsy technique still maintained a 21 percent detection, which is not different from previous reports from the same institution. (Author)