Comparative study of freehand and template-guided transperineal prostate biopsy in the detection rate of prostate cancer

Abstract

Objective This retrospective study compared the detection rates of prostate cancer between freehand transperineal biopsy(FTPB) and template-guided transperineal biopsy(TTPB) in the patients with PSA levels<20 ng/ml. Methods From April 2017 to April 2019, 768 patients with PSA levels <20 ng/ml were included into this study. Of these patients, 406 underwent FTPB procedures and 362 underwent TTPB procedures. There were no significant differences of median age [66.00(61.00, 70.00)vs. 66.00(61.00, 71.25)years], height [170.00(165.00, 172.00)vs. 170(165.00, 173.00)cm], weight [70.00(63.88, 75.00)vs. 70.00(63.75, 75.00)kg], BMI [24.22(22.22, 25.95)vs. 24.22(22.49, 25.82)kg/m2], PSA [8.75(6.49, 12.40)vs. 8.69(6.49, 11.96)ng/ml], fPSA [1.18(0.33, 2.15)vs. 1.15(0.76, 1.88)ng/ml], prostate volume [39.79(25.55, 53.94)vs. 39.88(24.46, 55.11)ml] between two groups. Patients’ biopsy results were recorded, the differences of prostate cancer detection rates between these two groups were analyzed, specifically including the cancer with Gleason score≥7 and the anterior zone cancer. Results The total prostate cancer detection rates were 33.7%(137/406) and 39.0%(141/362, P=0.134) in FTPB group and TTPB group respectively, and the detection rates of cancer with Gleason score≥7 were 23.9%(97/406) and 32.0%(116/362, P=0.012) respectively. The detection rates of anterior zone prostate cancer were 15.5% (63/406) and 27.3% (99/362, P<0.001). Moreover, in the patients with PSA <10 ng/ml, the prostate cancer detection rates were 29.8%(74/248) and 36.2%(81/224, P=0.144) respectively, while the detection rates of cancer with Gleason score≥7 were 19.4%(48/248) and 29.9%(67/224, P=0.008) respectively. Conclusions There was no significant difference in the total prostate cancer detection rates between 12-core TTPB group and 20-core FTPB group in the patients with PSA <20 ng/ml, but for the detection rate of cancer with Gleason score≥7, TTPB group was significantly higher than FTPB group, especially in the patients with PSA<10 ng/ml. In addition, for anterior zone prostate cancer, the detection rate of TTPB group was also higher than FTPB group. Key words: Prostatic neoplasms; Diagnosis; Freehand biopsy; Template-guided biopsy; Transperineal