Keywords
TRUSPNB
transperineal prostate sector biopsy
TPSB
prostate cancer
How to Cite
Abstract
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.