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Compаrative study: Efficacy and safety of MRI / ultrasound transperineal vs systematic transrectal prostate biopsy in patients with previous negative TRUS biopsy

Volume 9, Issue 1

Original Article / Published: November 2021


S.Hristoforov, O.Gatsev, P.Petrov, K.Petkova, I.Saltirov

Clinic of Endourology and SWL, Department of Urology and Nephrology Military Medical Academy of Sofia, Bulgaria


Introduction: The aim of the study was to compare the efficacy and safety of magnetic resonance imaging / ultrasound-targeted transperineal prostate biopsy versus standard transrectal systemic biopsy, in the detection of prostate cancer, in patients with evidence of previous negative systematic transrectal ultrasound prostate biopsy. Material and methods: From February 2019 to February 2021 in the Clinic of Endourology and SWL of the Military Medical Academy – Sofia, in 59 patients repeated prostate biopsy was performed after a previous negative systematic transrectal ultrasound-guided biopsy. In 35/59 patients in the group, MRI / ultrasound transperineal prostate biopsy was performed (group A), and in the remaining 24/59 patients a repeat systemic TRUS biopsy was performed (group B). The main indications for repeat prostate biopsy were persistently elevated PSA values, a finding on rectal digital examination, and/or a suspected area of prostate MRI. Results: Preoperative data were comparable in the two groups of patients, with no statistically significant differences. The mean value of PSA in group A was 17.27 ± 14.6 ng/ml, compared to 25.93 ± 24.19 ng/ml in group B, p = 0.264. MRI / ultrasound transperineal prostate biopsy revealed the presence of prostate cancer in 28 patients (80%) of the study group, compared to 8 patients (33.3%) in the group who underwent systematic TRUS biopsy, p = 0.001. The histopathological results of group A revealed the presence of low-grade prostate cancer in 15 patients (42.9%), compared to 13 patients (37.1%) in whom high-grade cancer was detected. The results show a statistically significant difference compared to patients in group B, where 3 patients (12.5%) showed low-grade prostate cancer, and 5 patients (20.8%) had a high-grade malignant process, p = 0.005. There was no statistically significant difference in intra- and postoperative complications in the two groups. Conclusion: Performing MRI / ultrasound targeted biopsy showed significantly higher efficacy and identical safety in diagnosing a prostate neoplastic process compared to standard 12-core transrectal systemic biopsy in patients with previous negative systemic TRUS biopsy.


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How to cite this article:

S.Hristoforov, O.Gatsev, P.Petrov, K.Petkova, I.Saltirov. Compаrative study: Efficacy and safety of MRI / ultrasound transperineal vs systematic transrectal prostate biopsy in patients with previous negative TRUS biopsy. Journal of Endourology and Minimally Invasive Surgery 2021; 9 (1): 36-42

Corresponding author:

S. Hristoforov,

Military Medical Academy of Sofia Department of Urology and Nephrology Clinic of Endourology and SWL

Sofia 1606, 3 “Georgi Sofiiski” blvd., Bulgaria