Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study

Abstract

BackgroundProstate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated.MethodsA total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score.ResultsThe cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085).ConclusionsPatients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.

A Comparison of Infectious Outcomes Between In-Office Transperineal Prostate Biopsies Without Antibiotic Prophylaxis and Transrectal Prostate Biopsies

“…In comparison, Meyer et al found a retention rate of 4.7% in their 43 patient transperineal biopsy experience (9). In addition, Huang et al reported a 3% rate of retention with TPB compared to a 12% rate after TRB, with risk factors being large prostate volume, bulging prostate transitional zone and high IPSS scores (25). Moreover, in both metaanalyses by Xiang et al and Shen et al, the retention rate after TPB was found to be to be similar to TRBand this was including MRI fusion-targeted biopsies and saturation biopsies that were not performed ino ce (8, 18).…”

Prostate biopsy techniques and pre-biopsy prophylactic measures: variation in current practice patterns in the Netherlands

“…Although, in our survey, we asked urologists mainly for solutions with in the field of antimicrobial prophylaxis, it is important to note that the solution does not have to be (solely) based on the use of adapted or rectal cultureguided antimicrobial prophylaxis. Various studies found favourable infection rates for transperineal PB compared to TRUSB with similar rates of prostate cancer detection [2,[28][29][30][31]. Therefore, transperineal PB is an obvious alternative biopsy approach to avoid infections from FQ resistant bacteria.…”

MiRNA-Based Inspired Approach in Diagnosis of Prostate Cancer

“…Due to the fact that a Complications of prostate biopsy include bacterial infections, hematospermia, hematuria, rectal bleeding, prostatitis or epididymitis urinary retention [8]. Gross hematuria occurs in about 13% of cases, urine retention in about 12%, epididymitis and prostatitis in 5%, UTI 12%, fever and sepsis in about 6.5% each [14]. A negative biopsy can also mean that there is no cancer and the biopsy was made in vain-the patient was subjected to an invasive maneuver without benefits.…”

“…As mentioned above, this procedure may be performed via a rectal or perineal approach. This is an invasive method, in addition there stand the postoperative complications (haematuria, infection, sepsis), [14] and is directly affected by the competence of the operator.…”