A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer.

BACKGROUND: The aim of this study was to analyze the differences between TRUSguided transrectal prostate biopsy (TR) and transperineal prostate biopsy (TP) in the diagnosis of prostate cancer. The two biopsy methods were evaluated in terms of diagnostic sensitivity and of early and late complications. METHODS: This retrospective study was realized through the review of clinical records of 219 men that received a prostate biopsy between 2004 and 2014. The biopsy was performed because of elevated prostate-specific antigen (PSA), abnormal digital rectal examination findings (DRE), abnormal transrectal ultrasound (TRUS) findings and symptoms due to prostate diseases. The cohort study was subdivided in two groups: 108 patients received a transrectal biopsy between 2004 and 2006 and 111 received a transperineal biopsy between 2007 and 2014. In both groups, first biopsy was performed with 12 cores scheme whereas second or third biopsy were performed with 18 cores scheme; in this study we excluded patients who underwent to biopsies with different number cores to reduce the bias. Both groups were evaluated on the basis of age, total PSA, PSA ratio (F/T), DRE/TRUS findings, presence/absence of low urinary tracts symptoms (LUTS), presence/absence of benign prostatic hyperplasia (BPH), histologic findings of biopsy cores and immediate/postoperative complications. Then, it was evaluated the overall cancer detection rate and the stratified cancer rate on the basis of the previous reported parameters. Finally, we analyzed the early and late complication rate in both groups. U Mann-Whitney test was used to evaluate the quantitative variables and χ2-test or Fisher exact test for qualitative variables. p < 0.05 was considered statistically significant. RESULTS: 66 cancers were detected in 219 patients of the study; 29 cancers were detected in the TP group and 37 in the TR group. There were no statistically significant differences in the overall cancer rate detected in both groups (26.13% e 34.26% respectively; p = 0.190). However, TP biopsy detected more cancers at first biopsy than TR biopsy (89.7% vs 78.4% respectively; p = 0.021). Moreover, TP biopsy detected more cancers in those patients with low cancer suspect (PSA < 4 ng/ml, F/T > 15%, negative TRUS), instead TR biopsy had more sensitivity in detecting cancer in those patients with high cancer suspect (PSA > 10 ng/ml, F/T < 15%, TRUS with abnormal lesions). The presence of BPH did not influence sensitivity in both cases. There were no significant differences in the early complication rate whereas a statistically significant difference was observed in the late complication rate (4% vs 11% in TP and TR biopsy, respectively; p = 0.019). CONCLUSIONS: No statistically significant differences in sensitivity were observed between TP and TR biopsy, but TP biopsy detected more cancers at first time biopsy. Complications rate was lower in the TP group. Therefore, we conclude that the Urologist has the final choice in deciding the most appropriate biopsy technique, considering sensitivity and complications.

Evaluation of urinary and general symptoms and correlation with other clinical parameters in interstitial cystitis patients.

AIMS: Interstitial cystitis (IC) has been deemed by some authors as a local manifestation of a systemic disease, particularly one of the autoimmune disorders. In order to provide an answer to the question whether IC patients do or do not indiscriminately report high scores for various somatic symptoms, we compared University of Wisconsin scores (U-W scores), including both urinary and non-urinary symptoms, for 30 IC female patients and 30 female controls. MATERIALS AND METHODS: A total of 30 female patients with IC and 30 healthy female controls were recruited for the study. All patients had to meet the symptom criteria established by the National Institute for Diabetes and Digestive and Kidney Diseases. Each patient completed a University of Wisconsin symptom scale, after translation (WICS). RESULTS: In the IC group median score was zero for all, but two of the reference symptoms: abdominal cramps and dizziness. All urinary symptoms were significantly increased in IC patients compared to controls. In the control group, the median value of urinary symptoms was zero. The duration of the disease was then related to IC symptoms in the patient group. Among the bladder-related symptoms, a good correlation was found for several specific symptoms and urinary symptoms as a whole. An association could be found between a positive potassium sensitivity test (PST) and burning bladder sensation, as well as pelvic discomfort. CONCLUSIONS: IC patients had significantly higher scores for the seven urinary symptoms compared to controls. The duration of disease was found to be correlated with the group of seven urinary symptoms.