ULTRASOUND GUIDED TRANSPERINEAL VS. TRANSRECTAL PROSTATE BIOPSY: A COMPARISON OF SIGNIFICANT CANCER DETECTION RATE

• Published in: Ultrasound in medicine & biology Vol. 48; p. S7
• Main Authors: Panus, Andrei, Hodorog, Mihai Cristian, Popescu, Tudor-Cristian-Timotei, Mitroi, George, Drocas, Andrei Ioan, Dragoescu, Petru Octavian
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2022
• Subjects: prostate biopsy; Prostate cancer; transperineal; transrectal; ultrasound guided; transrectal; prostate biopsy; Prostate cancer; transperineal; ultrasound guided
• ISSN: 0301-5629; 1879-291X
• DOI: 10.1016/j.ultrasmedbio.2022.04.038

Prostate cancer is the second most frequent cancer in men and the fourth most frequent cancer worldwide. In 2020, the new prostate cancer cases number was estimated at 1.4 million, from 1.27 million in 2018. Prostate biopsy is still the gold standard for prostate cancer diagnosis. Transrectal prostate biopsy (TR) was the first ultrasound-assisted way of performing prostate biopsy, while the transperineal prostate biopsy (TP) method has decreased risk of infectious complications and has been proven to achieve superior sampling of the anterior and apical regions. The prospective study took place between January 2019 and January 2021. A total of 310 (178 TP, 132 TR) patients from Craiova Emergency Hospital scheduled for ultrasound guided prostate biopsy were enrolled in this study in accordance with standard inclusion criteria (i.e. elevated PSA or suspicious DRE and PIRADS score 3-5 on mpMRI). The primary outcome assessment was clinically significant prostate cancer detection rate (Gleason score above 6) while the secondary endpoint was the evaluation of the complication rate. There were no significant differences between the two patient samples regarding age, BMI, symptoms (IPSS), prostate volume, PSA value, PIRADS score, Gleason score or T tumor staging. Pathology reports showed that overall prostate cancer detection rate was 55.80% (173 cases). Clinically significant prostate cancers were 47.09% (146 patients). TP and TR biopsies had a similar result in terms of clinically significant prostate cancer detection rate (TP: 49.44% vs. TR: 43.94%; p = ns.). However, TR biopsy had a significantly higher complication rate (TP: 6.74% vs TR: 14.39%, p < 0.05). Complications included urinary retention, hematuria or prostate infection. Our findings indicate that while TP and TR ultrasound guided prostate biopsy methods have a similar detection rate of clinically significant prostate cancer, TR approach has a significantly higher complication rate. We conclude that the ultrasound guided TP prostate biopsy approach should be considered as the preferred technique for prostate cancer diagnosis.