Transperineal template–guided prostate biopsy: 10 years experience in one center

Abstract

Objective To assess the efficacy and safety of transperineal template-guided prostate biopsy. Methods From Dec, 2003 to Dec 2013, a total of 3007 patients (30-91 years old, mean age 69 years old) who met the inclusion criteria underwent 11 regions transrectal ultrasound guided transperineal template prostate biopsy. The inclusion criteria included prostate-specific antigen (PSA) level more than 4.0 μg/L, abnormal prostate gland finding on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 μg/L (range 0.2-100 μg/L). The patients distribution in different PSA level included 176 cases (PSA 0-4.0 μg/L), 1179 cases (PSA 4.1-10.0 μg/L), 975 cases (PSA 10.1-20.0 μg/L) and 677 cases (PSA 20.1-100.0 μg/L). The prostate cancer detection rate in different PSA, prostate biopsy adverse effects, and prostate cancer spatial distribution were analyzed. Results A mean of 19 cores (ranged from 11 to 44 cores) were obtained for each biopsy. And more cores were performed in larger prostates than in smaller ones. One to four cores was implemented in each region. Prostate cancer was detected in 1 067 of 3 007 patients (35.5%). The prostate cancer detection rate in groups with PSA 0-4.0 μg/L, 4.1-10.0 μg/L, 10.1-20.0 μg/L, and 20.1-100.0 μg/L groups was 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), and 70.0% (474/677) respectively. The mean positives rate in prostate apex was higher than in other region [46.7% (499/1067) vs. 52.0% (555/1067), P=0.014]. Regarding adverse effects, 47.0% (1413/3007) reported hematuria, 6.1% (183/3007) developed hemospermia, 1.9% (57/3007) needed short-term catheterization after biopsy due to acute urinary retention, one patient suffered septicemia. Conclusions Transrectal ultrasound guided transperineal template prostate biopsy is a safe and accurate technique. The current study suggests that the positive detective rate in apical region is much higher than that in other region by using this technique. Key words: Prostate cancer; Biopsy; Transperineal; Template