Comparison of the results and complications for transrectal ultrasound guided versus transperineal mapping biopsy of the prostate

Vassilios M. Skouteris, Nelson N. Stone, Priya N. Werahera, Marios-Panagiotis Metsinis, Athanasios Dounis, Lucia M. Scott, Francisco G. La Rosa, David E. Crawford


Introduction: To compare the biopsy results and complication
rates in men undergoing TRUS- guided vs. transperineal mapping
biopsy (TPMB) of the prostate.
Materials and Methods: 379 men, of which 271 (71.5%) had a
prior TRUS-guided biopsy, had TPMB performed through template
with biopsies taken at 5 mm intervals. TRUS had a median
of 12 cores (range 6-26) sampled while the TPMB group had
51.5 (range16-151).
Results: Median age and PSA were 65 years (range 34-86) and
5.5 ng/ml (range 0.02-118). Of the 271 men with prior TRUS
biopsies, 89 (32.8%) had prostate cancer (Gleason score 6 in
76.1%). In contrast, 240/379 (63.3%) were diagnosed with prostate
cancer by TPMB with a median of 5.0 cores positive (range
1-37) for Gleason score 6 in 11 4 (47.5%), 7 in 102 (42.5%)
and 8-10 in 24 (10%). Of the 182 negative TRUS biopsies. 121
(66.5%) were positive by TPMB of which 62 (51.2%) were Gleason
score ≥ 7. 11/271 (4.1%) of the men who had TRUS biopsy
developed urinary tract infection compared to 3/379 (0.79%) of
those with mapping biopsy. No men developed retention after
TRUS biopsy while 30/379 (7.9%) did following TPMB. Older age (p = 0.010) and larger prostate volume (PV) (p = 0.016)

were associated with urinary retention. Men older than 65
years had 12.8% vs. 3.9% (OR 3.7, 95% CI 1.6-8.4, p = 0.001)
and PV > 42 cc had 13.4% vs. 2.7% (OR 5.7, 95% CI 2.1-15.1)
retention incidence.
Conclusion: Prostate cancer is diagnosed in twice as many men
with TPMB v. TRUS biopsy and detects cancer in two thirds of
men with a negative TRUS biopsy. TPMB is rarely associated
with infection but more commonly with urinary retention.


prostate cancer;transrectal ultrasound guided biopsy;transperineal mapping biopsy;biopsy results;complications

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