The Efficacy of Transrectal Ultrasound Guided Biopsy Versus Transperineal Template Biopsy of the Prostate in Diagnosing Prostate Cancer in Men with Previous Negative Transrectal Ultrasound Guided Biopsy

Purpose: We have previously demonstrated that transperineal template prostate biopsy (TPTPB) has a significantly higher cancer detection rate compared to transrectal ultrasound guided (TRUS) biopsy in biopsy naive men with a PSA < 20 ng/mL. We, therefore, performed a prospective study to determine whether TPTPB is still superior to TRUS biopsy in the detection of prostate cancer in men with persistently elevated PSA alter one previous negative set of TRUS biopsies. Materials and Methods: 42 patients with a background of one previous negative set of TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling digital rectal examination (DRE) underwent simultaneous standard 12-core TRUS biopsy and 36-core TPTPB under general anaesthesia. We determined the prostate cancer detection rate between the two diagnostic modalities. Results: Mean age was 65 years (range: 50-75), mean prostate volume was 59 cc (range: 21-152), mean PSA is 8.3 ng/L (range: 4.4-19), mean time difference between the study and the previous TRUS biopsy was 33 months (range: 1-150) with mean PSA velocity of 0.7 ng/mL/year (range: 0-8). Out of the 42 patients, 22 (52%) had benign pathology. Of the 20 patients (48%) diagnosed with prostate cancer, 4 (10%) had positive results in both TRUS biopsy and TPTPB, 1 (2%) had positive result in TRUS biopsy with negative TPTPB, while 15 (36%) had negative TRUS biopsy with positive TPTPB. Hence, TRUS biopsy detected cancer in 5/42 (12%) patients versus (19/42) 45% detected by TPTPB (P < 0.01). 13/19 (68%) of cancers detected by TPTPB had Gleason score square 7. A total of 82/141 (58%) of positive cores was found in the anterior zone. One patient (2%) experienced urosepsis, 2 (5%) temporary urinary retention, 14 (34%) mild haematuria and 13 (32%) haematospennia. Conclusion: TPTPB still shows a significantly higher prostate cancer detection rate compared to TRUS biopsy (12% versus 45%, P < 0.01) in men with a previous set of negative TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling prostate on DRE.