Detection rate of transperineal template-guided prostate biopsy in patients with persistently elevated PSA and prior negative biopsies

Abstract

Objective: To evaluate the cancer detection rate of transperineal template-guided biopsy in patients with persistently elevated PSA and prior negative biopsies. Moreover, the evaluation of the complication rate of this biopsy method is a secondary endpoint.

Material and Method: A retrospective review was performed of a total 35 patients with at least one prior TRUS biopsy who underwent transperineal-templated guided biopsy from 2014 to 2017. Standard template of brachytherapy material and transrectal ultrasound were fused together to confirm the accuracy of needle biopsy position. Space between the needles was 0.5 cm as a standard template.

Result: Patients had a mean 2.09 (range 1-5) prior biopsies. Average PSA was 16.02 ng/mL (range 5.57-53). Cancer was detected in 16 (45.7%) of 35 patients. Prostate cancer was found at the posterior apex of the prostate in 5 patients (31.25%), the anterior base in 4 (25%), the anterior apex of the prostate in 4 (25%), the posterior base of the prostate in 2 (12.5%), and the medial of the midgland in 1(6.25). Gleason
score was 3+4 or higher in 12 patients (80%) and 3+3 or lower in 3 (20%). Average number of cores was 33.18 (range 20-45). Average PSA density in the cancer group was 0.38 ng/mL/g (range 0.15-0.62); 25 patients (71.42%) had no complications, 3 (8.57%) had urinary retention, 3 (8.57%) had UTI, 3 (8.57%) had gross hematuria, and 1 (2.86%) had epididymo-orchitis. No patient with septicemia was found.  Patients in the cancer group had higher PSA density than the non-cancer group.

Conclusion: Transperineal template-guided biopsy is an effective and promising technique for the diagnosis of prostate cancer in patients with persistently elevated PSA and prior negative biopsies with a low complication rate. Most cancer cases were detected at the apex and base of the prostate.