Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association

Abstract

Objective To compare the clinically significant prostate cancer (csPC)‐detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. Patients and Methods This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging–Reporting and Data System (PI‐RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software‐guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12‐core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI‐RADS score. Results The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). Conclusion Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.

Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients

“…Koparal et al . reported that TP biopsy had a higher cancer detection rate than TR group in patients with prostate volumes > 100 mL (average PSA level 6.6 ng/mL) [ 18 ]. Moreover, when the prostate volume increases to more than 80 mL, there was no significant difference in cancer detection rate between two biopsy approaches in our study.…”

“…Moreover, there were no significant differences in both cancer detection rate and cancer core rate between TR and TP approaches for prostatic biopsy in most studies [ 13 – 16 ]. However, the detection rate of the two biopsy approaches may differ in patients of different ages, PSA values, and prostate volumes [ 17 , 18 ].…”

Clinical implementation PI-RADS v2.1: Detection rate of clinically significant prostate cancer in PI-RADS 4 and 5 categories–The Real-life data

“…In reviewing the literature conducted among the Middle East population, we found a few previous Turkish studies [11][12][13] evaluating PI-RADS v2.1 diagnostic performance. (Supplementary Table S3) Koparal et al [11] reported a 24.60% DR of csPCa in the fus-MRGB and systematic biopsy among 1143 biopsy naïve men or men with previous negative biopsies who had PI-RADS v2 and v2.1 scores ≥ 2. Conversely, our study illustrated a higher csPCa DR with a smaller sample size of PI-RADS 4 and 5 categories and the cog-MRGB (24.60% vs. 44.70%).…”

“…[9,10] To our best knowledge, a few previous studies among the Middle East population investigated the prebiopsy mp-MRI and PI-RADS v2.1 clinical implementation. [11][12][13] However, all of them were conducted in Turkey with heterogeneities according to prior biopsy status, PI-RADS versions, and PI-RADS score categories.…”

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

“…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. Therefore, the TP approach is preferred in patients with anterior and apical lesions due to its superiority in detecting csPCa [42] .…”