Utility of Transrectal Ultrasound Guided Transperineal Prostate Sector Biopsy in the Detection of Missed Prostate Cancer After a Previous Negative Transrectal Ultrasound Guided Systematic Extended Biopsy: An Observational Study

Utility of Transrectal Ultrasound Guided Transperineal Prostate Sector Biopsy in the Detection of Missed Prostate Cancer After a Previous Negative Transrectal Ultrasound Guided Systematic Extended Biopsy: An Observational Study
PropertyValue
Title:Utility of Transrectal Ultrasound Guided Transperineal Prostate Sector Biopsy in the Detection of Missed Prostate Cancer After a Previous Negative Transrectal Ultrasound Guided Systematic Extended Biopsy: An Observational Study
Author/Abstract:

Paulo Jesus F. Fernandez, MD and Jason L. Letran, MD, FPUA
Section of Urology, Department of Surgery, University of Santo Tomas Hospital

A substantial number of patients will present with persistently elevated serum prostate specific antigen
(PSA) after a previous negative Transrectal ultrasound guided prostate needle biopsy(TRUSPNB)
suggesting potentially missed cancers during the initial biopsy. Transperineal prostate sector biopsy
(TPSB), with its increased access to the undersampled anterior region, has been utilized to improve
cancer detection rate.

Objectives: The study aims to look into the ability of the TPSB to better detect potentially missed
cancers in a population of patients with previous negative TRUSPNB

Materials and Methods: This is an observational study based on a review of the biopsy database of the
senior author. A total of 26 patients underwent a repeat prostate biopsy due persistently elevated PSA
(>4.0 ng/ml) after an initial negative TRUSPNB biopsy were included. All patients underwent both
the TPSB followed by TRUSPNB at the same setting. Their overall cancer detection rates were
reported and compared.

Results: Among the 26 patients who underwent repeat prostate biopsy, TPSB was able to detect 14
cancers while the TRUSPNB detected only 3 cancers. The 54% (14/26) overall cancer detection rate
using TPSB is significantly higher than the 12% (3/26) overall cancer detection rate of TRUSPNB.
Subset analysis of the 15 cancers identified showed that the TPSB was able to detect 14 out of the 15
(93.3%) cancers while the TRUSPNB detected only 3 out of the 15 (20.0%) cancers .

Conclusion: The TPSB technique increases the prostate cancer detection rates in the subset of men
who undergo repeat biopsy after a previous negative TRUSPNB but still highly suspicious for
malignancy. Majority of the cancers in the repeat biopsy setting originated from the anterior zone
which may be quite difficult to be detected with the transrectal approach.

Key words: transrectal ultrasound guided prostate needle biopsy(TRUSPNB), transperineal prostate
sector biopsy(TPSB),prostate cancer

Filesize: 700.61 kB
Filetype:pdf (Mime Type: application/pdf)