Comparison of the results and complications for transrectal ultrasound guided versus transperineal mapping biopsy of the prostate

Vassilios M. Skouteris, Nelson N. Stone, Priya N. Werahera, Marios-Panagiotis Metsinis, Athanasios Dounis, Lucia M. Scott, Francisco G. La Rosa, David E. Crawford

Abstract


Introduction: To compare the biopsy results and complication
rates in men undergoing TRUS- guided vs. transperineal mapping
biopsy (TPMB) of the prostate.
Materials and Methods: 379 men, of which 271 (71.5%) had a
prior TRUS-guided biopsy, had TPMB performed through template
with biopsies taken at 5 mm intervals. TRUS had a median
of 12 cores (range 6-26) sampled while the TPMB group had
51.5 (range16-151).
Results: Median age and PSA were 65 years (range 34-86) and
5.5 ng/ml (range 0.02-118). Of the 271 men with prior TRUS
biopsies, 89 (32.8%) had prostate cancer (Gleason score 6 in
76.1%). In contrast, 240/379 (63.3%) were diagnosed with prostate
cancer by TPMB with a median of 5.0 cores positive (range
1-37) for Gleason score 6 in 11 4 (47.5%), 7 in 102 (42.5%)
and 8-10 in 24 (10%). Of the 182 negative TRUS biopsies. 121
(66.5%) were positive by TPMB of which 62 (51.2%) were Gleason
score ≥ 7. 11/271 (4.1%) of the men who had TRUS biopsy
developed urinary tract infection compared to 3/379 (0.79%) of
those with mapping biopsy. No men developed retention after
TRUS biopsy while 30/379 (7.9%) did following TPMB. Older age (p = 0.010) and larger prostate volume (PV) (p = 0.016)

were associated with urinary retention. Men older than 65
years had 12.8% vs. 3.9% (OR 3.7, 95% CI 1.6-8.4, p = 0.001)
and PV > 42 cc had 13.4% vs. 2.7% (OR 5.7, 95% CI 2.1-15.1)
retention incidence.
Conclusion: Prostate cancer is diagnosed in twice as many men
with TPMB v. TRUS biopsy and detects cancer in two thirds of
men with a negative TRUS biopsy. TPMB is rarely associated
with infection but more commonly with urinary retention.


Keywords


prostate cancer;transrectal ultrasound guided biopsy;transperineal mapping biopsy;biopsy results;complications

Full Text:

PDF

References


Biopsy Procedures Outlook to 2020, Global Data. July 2014.

Siegel R.L., Miller K.D., Jemal A., Cancer statistics, 2019. CA Cancer

J Clin 2019, 69(1):7-34.

Liss M.A., Ehdaie B., Loeb S., Meng M.V., Raman J.D., Spears V.,

Stroup S.P., An Update of the American Urological Association

White Paper on the Prevention and Treatment of the More Common

Complications Related to Prostate Biopsy. J Urol 2017.

Hodge K.K., McNeal J.E., Terris M.K., Stamey TA: Random systematic

versus directed ultrasound guided transrectal core biopsies of the

prostate. J Urol 1989, 142(1):71-74; discussion 74-75.

Presti J.C., Prostate biopsy: current status and limitations. Rev Urol

, 9(3):93-98.

Numao N., Kawakami S., Sakura M., Yoshida S., Koga F., Saito K.,

Masuda H., Fujii Y., Yamamoto S., Yonese J. et al., Characteristics

and clinical significance of prostate cancers missed by initial transrectal

-core biopsy. BJU Int 2012, 109(5):665-671.

Kawata N., Miller G.J., Crawford E.D., Torkko K.C., Stewart J.S., Lucia

M.S., Miller H.L., Hirano D., Werahera P.N., Laterally directed biopsies

detect more clinically threatening prostate cancer: computer

simulated results. Prostate 2003, 57(2):118-128.

Bigliocchi M., Marini M., Nofroni I., Perugia G., Shahabadi H., Ciccariello

M., Prostate cancer detection rate of transrectal ultrasonography,

digital rectal examination, and prostate-specific antigen: results

of a five-year study of 6- versus 12-core transperineal prostate biopsy.

Minerva Urol Nefrol 2007, 59(4):395-402; 403-396.

Huang H., Wang W., Lin T., Zhang Q., Zhao X., Lian H., Guo H.,

Comparison of the complications of traditional 12 cores transrectal

prostate biopsy with image fusion guided transperineal prostate

biopsy. BMC Urol 2016, 16(1):68.

Thomas S.V., Syam U., Devi J.S., Predictors of seizures during pregnancy

in women with epilepsy. Epilepsia 2012, 53(5):e85-88.

Mortezavi A., Keller E.X., Poyet C., Hermanns T., Saba K., Randazzo

M., Fankhauser C.D., Wild P.J., Moch H., Sulser T. et al., Clinical

impact of prostate biopsy undergrading in an academic and community

setting. World J Urol 2016, 34(10):1481-1490.

Haymart M.R., Miller D.C., Hawley S.T., Active Surveillance for

Low-Risk Cancers - A Viable Solution to Overtreatment? N Engl J

Med 2017, 377(3):203-206.

Loeb S., Vellekoop A., Ahmed H.U., Catto J., Emberton M., Nam R.,

Rosario D.J., Scattoni V., Lotan Y., Systematic review of complications

of prostate biopsy. Eur Urol 2013, 64(6):876-892.

Kojima M., Hayakawa T., Saito T., Mitsuya H., Hayase Y., Transperineal

-core systematic biopsy in the detection of prostate cancer.

Int J Urol 2001, 8(6):301-307.

Scott S., Samaratunga H., Chabert C., Breckenridge M, Gianduzzo

T: Is transperineal prostate biopsy more accurate than transrectal

biopsy in determining final Gleason score and clinical risk category?

A comparative analysis. BJU Int 2015, 116 Suppl 3:26-30.

Crawford E.D., Rove K.O., Barqawi A.B., Maroni P.D., Werahera P.N.,

Baer C.A., Koul H.K., Rove C.A., Lucia M.S., La Rosa F.G., Clinicalpathologic

correlation between transperineal mapping biopsies

of the prostate and three-dimensional reconstruction of prostatectomy

specimens. Prostate 2013, 73(7):778-787.

Ahmed H.U., Hu Y., Carter T., Arumainayagam N., Lecornet E.,

Freeman A., Hawkes D., Barratt D.C., Emberton M., Characterizing

clinically significant prostate cancer using template prostate

mapping biopsy. J Urol 2011, 186(2):458-464.

Crawford ED, Wilson SS, Torkko KC, Hirano D, Stewart JS, Brammell

C, Wilson RS, Kawata N, Sullivan H, Lucia MS et al: Clinical staging

of prostate cancer: a computer-simulated study of transperineal

prostate biopsy. BJU Int 2005, 96(7):999-1004.

El-Shater Bosaily A, Parker C, Brown LC, Gabe R, Hindley RG, Kaplan

R, Emberton M, Ahmed HU, Group P: PROMIS-Prostate MR imaging

study: A paired validating cohort study evaluating the role of

multi-parametric MRI in men with clinical suspicion of prostate

cancer. Contemp Clin Trials 2015, 42:26-40.

Barzell WE, Melamed MR: Appropriate patient selection in the focal

treatment of prostate cancer: the role of transperineal 3-dimensional

pathologic mapping of the prostate-a 4-year experience.

Urology 2007, 70(6 Suppl):27-35.

Záleský M, Stejskal J, Adamcova V et al. Use of Prostate Specific

Antigen Density Combined with Multiparametric Magnetic Resonance

Imaging Improves Triage for Prostate Biopsy. Urol Int 2019,

DOI: 10.1159/000500350.

Wagenlehner FM, Pilatz A, Waliszewski P, Weidner W, Johansen TE:

Reducing infection rates after prostate biopsy. Nat Rev Urol 2014,

(2):80-86.

Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, Loblaw DA, Trachtenberg

J, Stanimirovic A, Simor AE et al: Increasing hospital admission

rates for urological complications after transrectal ultrasound

guided prostate biopsy. J Urol 2010, 183(3):963-968.

Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol

MJ: Infectious complications and hospital admissions after prostate

biopsy in a European randomized trial. Eur Urol 2012, 61(6):1110-

Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S,

Weidner W, Loeb S: Complications After Systematic, Random, and

Image-guided Prostate Biopsy. Eur Urol 2017, 71(3):353-365.

Vyas L, Acher P, Kinsella J, Challacombe B, Chang RT, Sturch P, Cahill

D, Chandra A, Popert R: Indications, results and safety profile of

transperineal sector biopsies (TPSB) of the prostate: a single centre

experience of 634 cases. BJU Int 2014, 114(1):32-37.

Suzuki M, Kawakami S, Asano T, Masuda H, Saito K, Koga F, Fujii

Y, Kihara K: Safety of transperineal 14-core systematic prostate

biopsy in diabetic men. Int J Urol 2009, 16(12):930-935.

Symons JL, Huo A, Yuen CL, Haynes AM, Matthews J, Sutherland RL,

Brenner P, Stricker PD: Outcomes of transperineal template-guided

prostate biopsy in 409 patients. BJU Int 2013, 112(5):585-593.

Li H, Yan W, Zhou Y, Ji Z, Chen J: Transperineal ultrasound-guided

saturation biopsies using 11-region template of prostate: report

of 303 cases. Urology 2007, 70(6):1157-1161.

Mai Z, Yan W, Zhou Y, Zhou Z, Chen J, Xiao Y, Liang Z, Ji Z, Li H:

Transperineal template-guided prostate biopsy: 10 years of experience.

BJU Int 2016, 117(3):424-429.

Simsir A, Kismali E, Mammadov R, Gunaydin G, Cal C: Is it possible

to predict sepsis, the most serious complication in prostate biopsy?

Urol Int 2010, 84(4):395-399.

Vourganti S, Starkweather N, Wojtowycz A: MR/US Fusion Technology:

What Makes It Tick? Curr Urol Rep 2017, 18(3):20.

Ayres BE, Montgomery BS, Barber NJ, Pereira N, Langley SE,

Denham P, Bott SR: The role of transperineal template prostate

biopsies in restaging men with prostate cancer managed by active

surveillance. BJU Int 2012, 109(8):1170-1176.

Pham KN, Porter CR, Odem-Davis K, Wolff EM, Jeldres C, Wei JT,

Morgan TM: Transperineal Template Guided Prostate Biopsy Selects

Candidates for Active Surveillance - How Many Cores are Enough?

J Urol 2015, 194(3):674-679.

Radtke JP, Kuru TH, Bonekamp D, Freitag MT, Wolf MB, Alt CD,

Hatiboglu G, Boxler S, Pahernik S, Roth W et al: Further reduction

of disqualification rates by additional MRI-targeted biopsy with

transperineal saturation biopsy compared with standard 12-core

systematic biopsies for the selection of prostate cancer patients for

active surveillance. Prostate Cancer Prostatic Dis 2016, 19(3):283-

Grummet JP, Weerakoon M, Huang S, Lawrentschuk N, Frydenberg

M, Moon DA, O'Reilly M, Murphy D: Sepsis and 'superbugs': should

we favour the transperineal over the transrectal approach for

prostate biopsy? BJU Int 2014, 114(3):384-388.

Chiang IN, Chang SJ, Pu YS, Huang KH, Yu HJ, Huang CY: Major

complications and associated risk factors of transrectal ultrasound

guided prostate needle biopsy: a retrospective study of 1875 cases

in taiwan. J Formos Med Assoc 2007, 106(11):929-934.

Muthuveloe D, Telford R, Viney R, Patel P: The detection and upgrade

rates of prostate adenocarcinoma following transperineal

template-guided prostate biopsy - a tertiary referral centre experience.

Cent European J Urol 2016, 69(1):42-47.

Pepe P, Aragona F: Morbidity after transperineal prostate biopsy in

patients undergoing 12 vs 18 vs more than 24 needle cores.

Urology 2013, 81(6):1142-1146.

Womble PR, Linsell SM, Gao Y, Ye Z, Montie JE, Gandhi TN, Lane BR,

Burks FN, Miller DC, Michigan Urological Surgery Improvement C:

A Statewide Intervention to Reduce Hospitalizations after Prostate

Biopsy. J Urol 2015, 194(2):403-409.

Wagenlehner FM, van Oostrum E, Tenke P, Tandogdu Z, Cek M,

Grabe M, Wullt B, Pickard R, Naber KG, Pilatz A et al: Infective

complications after prostate biopsy: outcome of the Global Prevalence

Study of Infections in Urology (GPIU) 2010 and 2011, a

prospective multinational multicentre prostate biopsy study. Eur

Urol 2013, 63(3):521-527.

Marino K, Parlee A, Orlando R, Lerner L, Strymish J, Gupta K:

Comparative Effectiveness of Single versus Combination Antibiotic

Prophylaxis for Infections after Transrectal Prostate Biopsy.

Antimicrob Agents Chemother 2015, 59(12):7273-7275.

Stone NN, Stock RG: Complications following permanent prostate

brachytherapy. Eur Urol 2002, 41(4):427-433.

Shen PF, Zhu YC, Wei WR, Li YZ, Yang J, Li YT, Li DM, Wang J, Zeng

H: The results of transperineal versus transrectal prostate biopsy:

a systematic review and meta-analysis. Asian J Androl 2012,

(2):310-315.

Buskirk SJ, Pinkstaff DM, Petrou SP, Wehle MJ, Broderick GA, Young

PR, Weigand SD, O'Brien PC, Igel TC: Acute urinary retention after

transperineal template-guided prostate biopsy. Int J Radiat Oncol

Biol Phys 2004, 59(5):1360-1366.




DOI: http://dx.doi.org/10.19264/hj.v31i2.266