2124 TRANSPERINEAL TEMPLATE-GUIDED PROSTATE BIOPSY FOR PERSISTENTLY ELEVATED PSA FOLLOWING MULTIPLE NEGATIVE BIOPSIES

Abstract

INTRODUCTION AND OBJECTIVES: Patients with persistently elevated PSA despite multiple negative prostate biopsies pose a difficult clinical problem. We report our experience with the use of transperineal template-guided prostate biopsy for such patients. METHODS: A retrospective review was performed of patients with at least 2 negative prostate biopsies who underwent transperineal template-guided biopsy at the Massachusetts General Hospital. All patients underwent transperineal biopsy using a standard brachytherapy grid and transrectal ultrasound guidance under general anesthesia. Electronic medical records were reviewed to obtain relevant clinical, laboratory, and pathologic data. RESULTS: A total of 16 patients with a mean age of 64.6 4.4 years underwent transperineal template-guided prostate biopsy from 1/2009 through 9/2010. Mean number of prior biopsies per patient was 3.6 1.6 (range 2 – 7), including 5 (31.3%) patients who had prior negative TUR biopsy. Mean PSA, prostate volume, PSA density, and PSA velocity were 23.8 16.1 ng/ml, 62.5 31.3 ml, 0.46 0.42 ng / ml2, and 3.7 3.3 ng/ml/yr, respectively. A mean of 22.8 8.5 cores were obtained at biopsy. Prostate cancer was detected in 9 (56.3%) of the 16 patients. Of these, 8 (88.9%) patients had cancer in the anterior prostate. The distribution of Gleason score was as follows: 3 3 (n 4), 3 4 (n 2), 4 3 (n 1), 5 4 (n 1), focal 3 (n 1). Of the 9 patients with a diagnosis of cancer, 4 underwent radical prostatectomy, 1 elected active surveillance, 2 elected radiation therapy, and 2 were deciding therapy at the time of follow-up. Of the 7 patients with no cancer detected, 5 patients had no clinical change at a mean follow-up of 10.6 months and 2 patients were without follow-up data. One-way analysis of variance (ANOVA) was performed to compare variables between patients with and without detection of cancer (Table 1). Only prostate volume and PSA density were significantly different between the groups. CONCLUSIONS: Transperineal template-guided prostate biopsy is an effective technique for detecting cancer in patients with persistently elevated PSA despite multiple negative biopsies. This may result from improved sampling of the anterior prostate as suggested by the high proportion of such cancers in this series.