A comparative study on the diagnostic efficacy and safety of ultrasound-guided transperineal and transrectal prostate needle biopsy

ABSTRACT

@#<p style="text-align justify;"><strong>OBJECTIVE:</strong> To compare the diagnostic efficacy between the transperineal and the transrectal prostate needly biopsy as the initial biopsy strategy for detection of prostate cancer.<br /><strong>METHODS:</strong> A total of 179 patients with PSA of 2.5-20 ng/mL who underwent initial prostate needle biopsy were included. One hundred eight (108) patients underwent transrectal prostate needle biopsy (TRUS-BX) from March to December 2014, while 71 patients underwent transperineal prostate needle biopsy (TP-BX) from January 2015- August 2016. Descriptive statistics including mean, median and percentage were used for the patient demographics. Student's t-test was used to compare continuous variables between the two groups. X2 or Fisher's exact probability tests were used for categorical variables.<br /><strong>RESULTS:</strong> The mean age of the patients who underwent the TP-BX and TRUS-BX were 66.10 years and 62 years respectively (p=0.0003). The mean prostate volumes were 44.10 mL and 42.39 mL (p=0.5405), while the mean PSA were 9.51 ng/mL and 9.21 ng/mL (p=0.6096) for the TP-BX and TRUS-BX,respectively. The TP-BX provided a greater overall cancer detection rate of 63.38% (45/71) compared to 35.19% (38/108) obtained from the TRUS-BX (p<0.0001). Detection of clinically significant cancer, defined as Gleason score of 7 or higher was likewise greater in the TP-BX compared to the TRUS-BX (77.78% vs 55.26%; p=0.029). Among patients with PSA values of 2.5 ng/mL-10 ng/mL, cancer was detection was significantly higher in the TP-BX group (59.09% vs 31.11% p value=0.002). Cancer detection rates in patients with PSA 10ng/mL-20ng/mL were comparable in between the two groups (70.37% vs 55.56% p value =0.309). Of the patients who had cancer in the TP-BX group, 77.77%(35/45) involved in the anterior sector, 60% (27/45) the middle sector and 48.89% (22/45) the posterior sector. Thirteen out of the 35 cancers (37.14%) detected in the TP-BX group involved exclusively the anterior sector. The most common complication was hematuria at 35.21% for TP-BX and 50% for TRUS-BX. Complications that occurred exclusively for TRUS-BX included fever (2.78%) and 1 case (0.93%) of septicemia requiring hospitalization and parenteral antibiotics. Minor perienal bruising occurred exclusively in 8.45% of the patients who underwent TP-BX.<br /><strong>CONCLUSION:</strong> The transperineal prostate needle biopsy should be considered as the initial biopsy strategy for the detection of prostate cancer. The manifested advantages are the following a) The overall cancer detection rate is significantly higher, b) The detection rate of clinically significant cancer is significantly greater, c) It provides a far more superior detection of exclusive anterior zone cancers which are often under detected or undetected with the current standard TRUS-BX and d) Complications are comparable, if not fewer than the current standard TRUS-BX.</p>