Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study

Jiang, Chuanwen; Shen, Pengfei; Wang, Cheng; Gui, Haojun; Ruan, Yuan; Zeng, Hao; Xia, Shujie; Wei, Qiang; Zhao, Fu-Jun

doi:10.4103/aja.aja_16_19

Cited by 17 publications

(7 citation statements)

References 35 publications

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“…In addition, different cores, biopsy schemes, and operating techniques may lead to different detection rates of PCa, and prostate systematic multipoint biopsy may also fail to detect a part of the prostate cancer. 24 25 26 To confirm our findings, larger prospective randomized studies are needed.…”

Section: Discussionsupporting

confidence: 59%

Peripheral zone PSA density

Wang

et al. 2021

Asian Journal of Andrology

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To improve the diagnostic efficiency of prostate cancer (PCa) and reduce unnecessary biopsies, we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen (PSA) density (PZ-PSAD). Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital (Shanghai, China) between January 2012 and January 2018 were retrospectively identified ( n = 529). Another group of patients with benign prostatic hyperplasia ( n = 100) were randomly preselected to obtain the PSA density of the non-PCa cohort (N-PSAD). Prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging (mpMRI) and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific algorithm. Receiver operating characteristic (ROC) curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level, and the area under the ROC curve (AUC) of PZ-PSAD was higher than that of PSA, PSA density (PSAD), and transition zone PSA density (TZ-PSAD). PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography (TRUS) and mpMRI results. When TRUS and mpMRI findings were ambiguous to predict PCa (PIRADS score ≤3), PZ-PSAD could increase the positive rate of biopsy from 21.7% to 54.7%, and help 63.8% (150/235) of patients avoid unnecessary prostate biopsy. In patients whose PSA was 4.0–10.0 ng ml −1 , 10.1–20.0 ng ml −1 , and >20.0 ng ml −1 , the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml −2 , 0.297 ng ml −2 , and 1.180 ng ml −2 , respectively (sensitivity >90%). Compared with PSA, PSAD, and TZ-PSAD, the efficiency of PZ-PSAD for predicting PCa is the highest, leading to fewer missed diagnoses and unnecessary biopsies.

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Section: Discussionsupporting

confidence: 59%

Peripheral zone PSA density

Wang

et al. 2021

Asian Journal of Andrology

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“…Even through image-guided TB, the detection of any PCa or csPCa is still similar [39] . However, some research showed that TP biopsy had a higher detection rate of csPCa than TR biopsy for all patients [40] . A prospective study carried out by Pietro Pepe et al [41] showed that mpMRI/TR ultrasound (TRUS) cognitive targeted TP biopsy could find a greater percentage of csPCa in the anterior zone, compared with the TR approach.…”

Section: Comparison Of Transperineal and Transrectal Prostate Biopsymentioning

confidence: 96%

“…Even through image‐guided TB, the detection of any PCa or csPCa is still similar [ 39 ] . However, some research showed that TP biopsy had a higher detection rate of csPCa than TR biopsy for all patients [ 40 ] . A prospective study carried out by Pietro Pepe et al.…”

Section: Comparison Of Transperineal and Transrectal Prostate Biopsymentioning

confidence: 99%

Indications, strategies, and development on prostate targeted biopsy: Report of the Panjiayuan Consensus Conference 2022

Gang

Hou

et al. 2023

UroPrecision

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“…In total, 768 studies were identi ed from the initial search. Of these, 18 trials met the inclusion criteria, including 8 RCTs[26-33] and 10 case-control studies (CCSs) [9,16,17,19,[34][35][36][37][38][39](Table 1).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Cancer detection rate across all studies Data relating to extensive prostate biopsy were available from 10 CCSs [9,16,17,19,[34][35][36][37][38][39] and 8 RCTs. [26][27][28][29][30][31][32][33] There was no signi cant overall difference in cancer detection rate between TR (1059/2836) and TP (1251/3072) groups (RD=-0.03; 95% CI: -0.07-0.01; P=0.14) (Figure 1 A).…”

Section: Cancer Detection Ratementioning

confidence: 99%

The results of transperineal versus transrectal prostate extension biopsy: an updated systematic review and meta-analysis

Dai

Zeng

Wang

et al. 2023

Preprint

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This systematic review was performed to compare the current understanding of the relative efficacies and complications associated with transperineal (TP) vs. transrectal (TR) prostate biopsy. All clinical controlled trials reporting prostate cancer (PCa) detection rates and complications associated with TP and TR biopsies were systematically identified, including extensive biopsy procedures. A subgroup analysis was performed to assess the impact of certain clinical factors, e.g., prostate-specific antigen (PSA). The pooled analysis for randomized controlled trials (RCTs) combined with comparative case studies (CCSs) showed no difference in the cancer detection rate between TR and TP (risk difference (RD)=-0.01; 95% confidence interval (CI): -0.04–0.02; P = 0.37). There was no significant difference in the cancer detection rate for RCTs (RD=-0.001; 95%CI: -0.006-0.003; P = 0.55) or CCSs (RD=-0.01; 95%CI: -0.05-0.03; P = 0.59). However, more PCa was detected in the subgroup with PSA ≥ 10 ng/ml (RD = 0.07; 95%CI: 0.01–0.13; P = 0.09) and the subgroup with PSA ≥ 20 ng/ml (RD = 0.13; 95%CI: 0.05–0.20; P = 0.001) using TR biopsy across all studies, while this advantage of TR was not found in RCTs alone (RD = 0.13; 95%CI: -0.09-0.35; P = 0.24). And TP detected more PCa in patients with positive mpMRI in MRI-targeted biopsy, with an accuracy rate of 48.5% (205/423) compared to 34.2% (146/427) for the TR route (RD = 0.51; 95%CI: 0.38–0.68; P < 0.01). There was a significantly lower risk of fever (RD = 0.03; 95%CI: 0.01–0.05; P = 0.003) and rectal bleeding (RD = 0.08; 95%CI: 0.01–0.14; P = 0.02) with TP. In conclusion, there was no significant difference in the cancer detection rate between TR and TP, however, TP had advantage over TR in MRI-targeted biopsy; while TP was safer than TR, due to lower risks of fever and rectal bleeding.

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Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study

Cited by 17 publications

References 35 publications

Peripheral zone PSA density

Peripheral zone PSA density

Indications, strategies, and development on prostate targeted biopsy: Report of the Panjiayuan Consensus Conference 2022

The results of transperineal versus transrectal prostate extension biopsy: an updated systematic review and meta-analysis

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