188 THE SUPERIORITY OF TRANSPERINEAL TEMPLATE MAPPING BIOPSY OF THE PROSTATE GLAND OVER THE TRANSRECTAL SATURATION APPROACH

Abstract

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011188 THE SUPERIORITY OF TRANSPERINEAL TEMPLATE MAPPING BIOPSY OF THE PROSTATE GLAND OVER THE TRANSRECTAL SATURATION APPROACH Stuart McCracken, Sarah Housley, Jose Dominguez-Escrig, Krishna Narahari, and Damian Greene Stuart McCrackenStuart McCracken Sunderland, United Kingdom More articles by this author , Sarah HousleySarah Housley Sunderland, United Kingdom More articles by this author , Jose Dominguez-EscrigJose Dominguez-Escrig Sunderland, United Kingdom More articles by this author , Krishna NarahariKrishna Narahari Sunderland, United Kingdom More articles by this author , and Damian GreeneDamian Greene Sunderland, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.258AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Attempts to maximise the effectiveness of repeat biopsy has given rise to the alternate approaches of saturation biopsy and the transperineal approach. Recent interest in focal treatment of prostate cancer has further highlighted the need for accurate detection of prostate cancer and in response, the introduction of transperineal template mapping biopsy (TTMB). In this study we aim to compare transrectal saturation and TTMB in men attending for repeat prostate biopsy. METHODS The study included 100 consecutive patients who required repeat biopsy based on rising PSA despite previous negative biopsy. The first 50 patients underwent transrectal saturation biopsies (mean age 65, range 52–77) and the second 50 patients underwent TTMB (mean age 62.9, range 37–75), utilizing a 5mm brachytherapy grid template. Median number of cores=18 (range 11–24) for transrectal saturation biopsy, median number of cores=44 (range 24–65) for TTMB. In the TTMB group, 10 patients opted for radical prostatectomy, allowing pathological comparisons of biopsy specimens and step-sectioned radical prostatectomy specimens. RESULTS Prostate cancer was detected in 46% (23/50) of the 50 TTMB performed, compared with 22% (11/50) for transrectal saturation biopsy. Of the TTMB biopsies positive for cancer, 43% (10/23) were unilateral and therefore suitable for focal hemi-cryotherapy. Of the TTMB biopsies positive for cancer 26% (6/23) had apical cancer alone, a zone at risk of inadequate sampling with the traditional transrectal route. Good correlation was seen between both groups with 1 out of 10 patients (10%) upgraded from unilateral to bilateral adenocarcinoma on radical prostatectomy histology. TTMB had a complication rate of 12% (5 patients with acute retention of urine, 1 hematuria requiring admission) compared with a complication rate of 22% for the transrectal saturation biopsy group (4 patients with UTI, 1 acute retention of urine, 2 hematuria requiring admission). CONCLUSIONS TTMB has a similar morbidity to transrectal saturation technique. Our study demonstrates that cancer detection rate is higher in patients who undergo TTMB (46% Vs 22%). Detection rate may be higher in TTMB due to better apical and anterior peripheral zone sampling. Despite the requirement for general anaesthesia and a potential increased urinary retention rate, novel transperineal mapping schemes allow for more accurate sampling of the entire gland. The remit of prostate biopsy now lies beyond pure diagnostics and has become an essential tool for determining optimal therapeutic approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e78 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stuart McCracken Sunderland, United Kingdom More articles by this author Sarah Housley Sunderland, United Kingdom More articles by this author Jose Dominguez-Escrig Sunderland, United Kingdom More articles by this author Krishna Narahari Sunderland, United Kingdom More articles by this author Damian Greene Sunderland, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...