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.
- Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound-guided transrectal core biopsies of the prostate. J Urol. 1989 Jul;142(1):71-4;
- Hu Y, Ahmed HU, Carter T, Arumainayagam N, Lecornet E, Barzell W, et al. A biopsy simulation study to assess the accuracy of several transrectal ultrasonography (TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy. BJU Int 2012;110:812-20.
- Ravery V, Dominique S, Panhard X, et al. The 20-core prostate biopsy protocol – a new gold standard? J Urol. 2008;179:504– 7
- Scattoni V, Raber M, Abdollah F, et al. Biopsy schemes with the fewest cores for detecting 95% of the prostate cancers detected by a 24-core biopsy. Eur Urol. 2010;57:1–8
- Scattoni V, Roscigno M, Raber M, et al. Initial extended transrectal prostate biopsy – are more prostate cancers detected with 18 cores than with 12 cores? J Urol. 2008; 179:1327–31
- Presti JC Jr, Chang JJ, Bhargava V, Shinohara K.The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol. 2000;163(1):163-166
- Ravery V, Goldblatt L, Royer B, Blanc E, Toublanc M, BocconGibod L. Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol. 2000;164(2):393-396
- Gore JL, Shariat SF, Miles BJ et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol. 2001;165(5):1554-1559
- de la Taille A, Antiphon P, Salomon L, et al. Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology. 2003;61(6):1181-1186
- Joseph H. Yacoub, MD, Sadhna Verma, MD, Jonathan S. Moulton, MD et al. Imaging-guided Prostate Biopsy: Conventional and Emerging Techniques Volume 32, Issue 3 May, June 2012
- Steyn JH, Smith FW. Nuclear magnetic resonance imaging of the prostate. Br J Urol 1982; 54:726-728
- Komai Y, Numao N, Yoshida S. High Diagnostic Ability of Multiparametric Magnetic Resonance Imaging to Detect Anterior Prostate Cancer Missed by Transrectal 12-Core Biopsy J Urology Volume 190 Issue 3 2013 Page: 867-873
- Hricak H, Williams RD, Spring DB, et al. Anatomy and pathology of the male pelvis by magnetic resonance imaging. AJR Am J Roentgenol. 1983; 141:1101–1110. [PubMed: 6196961]
- Turkbey B, Pinto PA, Mani H, Bernardo M, Pang Y, McKinney YL, et al. Prostate cancer: value of multiparametric MR imaging at 3 T for detection–histopathologic correlation. Radiology 2010;255:89-99.
- Thompson JE, Moses D, Shnier R, Brenner P, Delprado W, Ponsky L, et al. Multiparametric magnetic resonance imaging-guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study. J Urol 2014;192:67-74.
- Rud E, Klotz D, Rennesund K, Baco E, Berge V, Lien D, et al. Detection of the index tumour and tumour volume in prostate cancer using T2-weighted and diffusion-weighted magnetic resonance imaging (MRI) alone. BJU Int 2014;114:E32-42.
- Arumainayagam N, Ahmed HU, Moore CM, Freeman A, Allen C, Sohaib SA, et al. Multiparametric MR imaging for detection of clinically significant prostate cancer: a validation cohort study with transperineal template prostate mapping as the reference standard. Radiology 2013;268:761-9.
- Kaplan I, Oldenburg NE, Meskell P, et al. Real-time MRI-ultrasound image-guided stereotactic prostate biopsy. Magn Reson Imaging. 2002; 20:295–299. [PubMed: 12117612]1
- Borkowetz A, Platzek I, Toma M et al. Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound-fusion biopsy for the diagnosis of prostate cancer. BJUI Dec 2015, Vol 116 Issue 6, Pages 873-879, https://doi.org/10.1111/bju.13023
- A Peltier, F Aoun, M Lemort, “MRI-Targeted Biopsies versus Systematic Transrectal Ultrasound Guided Biopsies for the Diagnosis of Localized Prostate Cancer in Biopsy Naïve Men”, BioMed Research International, vol. 2015, Article ID 571708, 6 pages 2015, https://doi.org/10.1155/2015/571708
- Maxeiner A, Stephan C, Fischer T et al. Real-time MRI/US fusion-guided biopsy in biopsy-naïve and pre-biopsied patients with suspicion for prostate cancer. Aktuelle Urol. 2015 Jan;46(1):34-8. German. doi: 10.1055/s-0034-1395563. Epub 2014 Dec 17. PMID: 25519051.
- Magne Dimmen, Ljiljana Vlatkovic, Knut-Håkon Hole et al. Transperineal prostate biopsy detects significant cancer in patients with elevated prostate-specific antigen (PSA) levels and previous negative transrectal biopsies. BJU International, Volume 110, Issue 2b. https://doi.org/10.1111/j.1464-410X.2011.10759.x
- Pepe P, Pennisi M, Fraggetta F. Anterior prostate biopsy at initial and repeat evaluation: is it useful to detect significant prostate cancer?. Int Braz J Urol. 2015;41(5):844-848. doi:10.1590/S1677-5538.IBJU.2014.0234
- Cowan T, Baker E, McCray G, Reeves F, Houlihan K, Johns-Putra L. Detection of clinically significant cancer in the anterior prostate by transperineal biopsy. BJU Int. 2020 Sep;126 Suppl 1:33-37. doi: 10.1111/bju.15124. Epub 2020 Aug 4. PMID: 324639772
- Sahu M, Wijesekera N, Donohue JF. Anterior prostate cancer: Current perspectives and diagnostic dilemmas. Journal of Clinical Urology. 2017;10(1):49-55. doi:10.1177/2051415816655724
- Huang H, Wang W, Lin T, Zhang Q, Zhao X, Lian H, Guo H. Comparison of the complications of traditional 12 cores transrectal prostate biopsy with image fusion guided transperineal prostate biopsy. BMC Urol. 2016 Nov 17;16(1):68. doi: 10.1186/s12894-016-0185-z. PMID: 27855661; PMCID: PMC5114768.
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
Military Medical Academy of Sofia Department of Urology and Nephrology Clinic of Endourology and SWL
Sofia 1606, 3 “Georgi Sofiiski” blvd., Bulgaria