Elsevier

Urology

Volume 77, Issue 4, April 2011, Pages 921-925
Urology

Prostate Cancer: Screening and Diagnosis
Trans-rectal Versus Trans-Perineal Saturation Rebiopsy of the Prostate: Is There a Difference in Cancer Detection Rate?

https://doi.org/10.1016/j.urology.2010.08.048Get rights and content

Objective

To test the hypothesis that there is no significant difference in the rate of prostate cancer (PCa) detection rate between the transrectal and transperineal approach in men undergoing a saturation (24-core) prostate rebiopsy.

Methods

We evaluated 472 consecutive men who underwent a 24-core prostate rebiopsy at 2 tertiary referral centers. Of these, 70% (332) underwent a transrectal biopsy, and 30% (140) underwent a transperineal biopsy. Propensity score was used to match 280 patients with homogeneous characteristics; those represented the final study cohort. Univariable and multivariable logistic regression analyses were used to address the relationship between biopsy approach and PCa detection rate. Covariates consisted of age at biopsy, prostate-specific antigen, total prostate volume, digital rectal examination findings, histologic findings on previous biopsy, and the number of previous negative biopsy sets.

Results

Overall, PCa detection rate was 28.6%. There was no statistically significant difference in PCa detection rate between the transrectal and transperineal approach (31.4% vs 25.7%, respectively; P = .3). The type of approach was not an independent predictor of PCa detection rate at multivariable analyses (odds ratio = 0.61, P = .1).

Conclusions

Transrectal and transperineal prostate saturation biopsies have a similar PCa detection rate in men undergoing a saturation rebiopsy. Both approaches can be offered to men undergoing a prostate rebiopsy without undermining the rate of PCa detection.

Section snippets

Study Population

Data were prospectively collected from 472 men who consecutively underwent an ultrasound-guided 24-core prostate rebiopsy (saturation biopsy) at 2 academic tertiary referral centers. Data analyses for the purpose of this study were done retrospectively. Overall, 332 (70.3%) underwent a transrectal 24-core biopsy at the urology unit of the University Vita-Salute/San Raffaele in Milan. The remaining 140 (29.7%) underwent a transperineal 24-core biopsy at the urology unit of the university of

Results

Table 1 shows the characteristics of 280 matched patients. Average age was 66.3 years (median: 66.6, range: 47.6–82.1). Mean PSA was 9.8 ng/mL (median: 8.6, range: 0.9–31.5). Average total prostate volume was 63.9 mL (median: 58.5, range 15.0–198.0). DRE was pathologic in 11.1% of patients. The rates of a previous HGPIN and ASAP were, respectively, 5.4% and 18.9%. The numbers of previous biopsy sets were 1, 2, 3, and ≥4 in, respectively, 54.3, 31.8%, 11.4%, and 2.5% of patients. Overall, the

Comment

An important factor that may affect the rate of PCa detection of prostate biopsy is the approach used to perform it.6, 9, 10, 11 Theoretically, because the cores of the transperineal approach are directed longitudinally to the peripheral zone of the prostate, this approach should have a better PCa detection ability than the transrectal approach. Moreover, the transperineal approach should allow more accurate sampling of the anterior part of the gland. A previous report observed a higher PCa

Conclusions

Transrectal and transperineal prostate saturation biopsies have a similar likelihood of detecting PCa in men undergoing a saturation rebiopsy. Both approaches can be offered to men undergoing a prostate rebiopsy without undermining the rate of PCa detection.

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    Extended prostate biopsy with a scheme of 14, 18, 24 or saturation biopsies up to 50 cores were performed mostly via a trans-perineal approach during repeated biopsy to increase PCa detection. Although the trans-perineal approach has not resulted in a higher detection rate than transrectal biopsies, according to several authors, the complication rate is lower, especially infectious complications with a 0–1% report of fever in the different series [30,31]. This procedure remains more invasive, and usually requires a general anesthesia which is clearly a limitation.

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