Journal List > Korean J Urol > v.50(2) > 1005255

Chae, Kim, Kim, Yun, Lee, and Kim: The Comparison between Transperineal and Transrectal Ultrasound-Guided Prostate Needle Biopsy

Abstract

Purpose

Prostate biopsy is a conventional method for the detection of prostate cancer in men with suspicious findings. However, there is no universal agreement on which method is the better approach to the prostate, with regard to cancer detection rate and complication rate. In this prospective randomized study, we compared cancer detection rates and complication rates between transperineal (TP) and transrectal (TR) prostate biopsy.

Materials and Methods

Between March 2006 and December 2007, we analyzed 200 Korean men. One hundred patients underwent randomized TP prostate biopsy and 100 patients underwent TR prostate biopsy. All biopsies were extended 12-core biopsies. With both approaches, 12 biopsy specimens were obtained systematically from the peripheral and transitional zones, including the apex, base, and transitional zone. The patient's subjective pain scale was measured by use of visual analogue scales. Immediately after the biopsy, the pain score was independently recorded by the patients. One week later, various complications were measured by answer note.

Results

The overall cancer detection rate was 22% (22 of 100 patients) with TR prostate biopsy and 29% (29 of 100 patients) with TP prostate biopsy. Considering the prostate cancer detection rate, there were no significant differences between the groups for prostate-specific antigen (PSA), age, body mass index (BMI), and prostate volume. Apart from the cancer detection rate and complication rate, the pain scale, in each different approach, was statistically meaningful.

Conclusions

There were no significant differences in the cancer detection rate or complication rate between TP and TR prostate needle biopsy. However, with regard to pain relief and complication rates, TR prostate needle biopsy is preferable.

Figures and Tables

Table 1
Baseline patients characteristics
kju-50-119-i001

BMI: body mass index, PSA: prostate-specific antigen, TP: transperineal prostate biopsy, TR: transrectal prostate biopsy, TRUS: transrectal ultra sonography, a: Student's t-test

Table 2
Cancer detection rate according to PSA, age, BMI and prostate volume
kju-50-119-i002

BMI: body massindex, PSA: prostate-specific antigen, TP: transperineal prostate biopsy, TR: transrectal prostate biopsy, TRUS: transrectal ultra sonography, a: chi-square test

Table 3
Complication rates by prostate biopsy method
kju-50-119-i003

TP: transperineal prostate biopsy, TR: transrectal prostate biopsy, a: chi-square test, b: Fisher's exact test

Notes

This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MEST) (PT-ERC).

References

1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008. 58:71–96.
2. Kim JH, Chang SG, Kim YW. Pathologic diagnosis and clinical findings in patients undergoing transrectal prostatic biopsy. Korean J Urol. 2000. 41:492–499.
3. Cancer Registration and Biostatistics Branch, National Cancer Center. Cancer Statistics in Korea. 2007.
4. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989. 142:71–74.
5. Norberg M, Egevad L, Holmberg L, Sparen P, Norlen BJ, Busch C. The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology. 1997. 50:562–566.
6. Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998. 279:1542–1547.
7. Cho SH, Kim SI, Park HY. The efficacy of routine sextant prostate biopsy plus selective lesion-directaed prostate biopsy. Korean J Urol. 2005. 46:700–703.
8. Kawakami S, Hyochi N, Yonese J, Yano M, Fujii Y, Kageyama Y, et al. Three-dimensional combination of transrectal and transperineal biopsies for efficient detection of stage T1c prostate cancer. Int J Clin Oncol. 2006. 11:127–132.
9. Kawakami S, Yamamoto S, Numao N, Ishikawa Y, Kihara K, Fukui I. Direct comparison between transrectal and transperineal extended prostate biopsy for the detection of cancer. Int J Urol. 2007. 14:719–724.
10. Emiliozzi P, Corsetti A, Tassi B, Federico G, Martini M, Pansadoro V. Best approach for prostate cancer detection: a prospective study on transperineal versus transrectal six-core prostate biopsy. Urology. 2003. 61:961–966.
11. Watanabe M, Hayashi T, Tsushima T, Irie S, Kaneshige T, Kumon H. Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection. Int J Urol. 2005. 12:959–963.
12. Miller J, Perumalla C, Heap G. Complications of transrectal versus transperineal prostate biopsy. ANZ J Surg. 2005. 75:48–50.
13. Kristal AR, Chi C, Tangen CM, Goodman PJ, Etzioni R, Thompson IM. Associations of demographic and lifestyle characteristics with prostate-specific antigen (PSA) concentration and rate of PSA increase. Cancer. 2006. 106:320–328.
14. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999. 282:1530–1538.
15. Amling CL, Kane CJ, Riffenburgh RH, Ward JF, Roberts JL, Lance RS, et al. Relationship between obesity and race in predicting adverse pathologic variables in patients undergoing radical prostatectomy. Urology. 2001. 58:723–728.
16. Furuno T, Demura T, Kaneta T, Gotoda H, Muraoka S, Sato T, et al. Difference of cancer core distribution between first and repeat biopsy: in patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy. Prostate. 2004. 58:76–81.
17. Eskew LA, Woodruff RD, Bare RL, McCullough DL. Prostate cancer diagnosed by the 5 region biopsy method is significant disease. J Urol. 1998. 160:794–796.
18. Eskicorapci SY, Tuncay L. Re: Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review. Eichler K, Hempel S, Wilby J, Myers L, Bachmann LM, Kleijnen J. J Urol 2006;175:1605-12. J Urol. 2006. 176:2745–2746.
19. Jeon SB, Zhao C, Jung YB, Park YK, Park JK. A protocol for transrectal, ultrasonography-guided 41-core prostate needle biopsy. Korean J Urol. 2008. 49:122–126.
20. Kang T, Song C, Song GH, Shin GH, Shin DI, Kim CS, et al. The anatomic distribution and pathological characteristics of prostate cancer: a mapping analysis. Korean J Urol. 2006. 47:578–585.
21. Hollabaugh RS Jr, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology. 1997. 49:426–434.
22. Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, et al. A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: The Emory University experience. J Urol. 2000. 164:397–399.
23. Desgrandchamps F, Meria P, Irani J, Desgrippes A, Teillac P, Le Duc A. The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study. BJU Int. 1999. 83:1007–1009.
24. Byun SS, Lee HJ, Ku JH, Park K, Lim DJ, Lee SE, et al. Effect of periprostatic nerve blockade for transrectal ultrasound guided biopsy of the prostate. Korean J Urol. 2004. 45:663–666.
25. Thompson PM, Pryor JP, Williams JP, Eyers DE, Dulake C, Scully MF, et al. The problem of infection after prostatic biopsy: the case for the transperineal approach. Br J Urol. 1982. 54:736–740.
26. Webb JA, Shanmuganathan K, McLean A. Complications of ultrasound-guided transperineal prostate biopsy. A prospective study. Br J Urol. 1993. 72:775–777.
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