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.
Highlights
Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis
In the TP group, though there were 2.2 and 0.7% of patients who were further diagnosed with urinary tract infection (UTI) and prostatitis, no one else was shown to get epididymitis, fever, and sepsis following the bioptic procedure
Except for prostatitis and epididymitis, all infection-related complications were lower in the TP group. (Table 2.)
Summary
Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. The transrectal (TR) ultrasound-guided biopsy is the gold standard approach for prostate cancer diagnosis [1, 2]. Transperineal (TP) biopsy is an alternative approach for patients required to undergo prostate repeat biopsy. This procedure has been shown to greatly improve the cancer detection rates in the anterior and apical areas of the prostate and reduce the risk for infectious complications [6, 7]. We compared the rates of cancer detection and post-bioptic complications between the Taiwanese patients receiving transperineal (TP) and transrectal (TR) prostate biopsies, respectively. Comparisons of visual analog scale (VAS) scores between these two patient groups were done for evaluating the feasibility of TP under local anesthesia
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