Investig Clin Urol.  2019 Nov;60(6):454-462. 10.4111/icu.2019.60.6.454.

The clinical utility of transperineal template-guided saturation prostate biopsy for risk stratification after transrectal ultrasound-guided biopsy

• Song W
• Kang M
• Jeong BC
• Seo SI
• Jeon SS
• Lee HM
• Jeon HG

• KMID: 2461057
• DOI: http://doi.org/10.4111/icu.2019.60.6.454

Abstract

PURPOSE
To investigate the clinical utility of transperineal template-guided saturation prostate biopsy (TPB) for risk stratification after transrectal ultrasound (TRUS)-guided biopsy.
MATERIALS AND METHODS
We retrospectively reviewed 155 patients who underwent TPB after previously negative results on TRUS-guided biopsy (n=58) or who were candidates for active surveillance (n=97) fulfilling the PRIAS criteria between May 2017 and November 2018. The patients' clinicopathologic data were reviewed, and the detection of clinically significant cancer (CSC) and upgrading of Gleason grade were identified.
RESULTS
The patients' median age and pre-TPB prostate-specific antigen (PSA) value were 65.0 years and 5.74 ng/mL, respectively. A median of 36 biopsy cores was obtained in each patient, with a median TPB core density of 0.88 cores/cm³. Of the 58 males with a previous negative result on TRUS-guided biopsy, prostate cancer (PCa) was detected in 17 males (29.3%), including 8 with CSC. Of the 97 patient candidates for active surveillance, upgrading of the Gleason grade was identified in 31 males (32.0%), 20 with a Gleason grade of 7 (3+4), 6 with a Gleason grade of 7 (4+3), and 5 with a Gleason grade of 8 (4+4). The overall complication rate was 14.8% (23/155), and there were no Clavien-Dindo grade 3 to 5 complications.
CONCLUSIONS
TPB helps to stratify the risk of PCa that was previously missed or underdiagnosed by TRUS-guided biopsy. TPB might be used as a diagnostic tool to determine risk classification and to help counsel patients with regard to treatment decisions.

Keyword

Biopsy; Prostatic neoplasms; Risk; Watchful waiting

MeSH Terms

Biopsy*
Classification
Humans
Male
Passive Cutaneous Anaphylaxis
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms
Retrospective Studies
Ultrasonography
Watchful Waiting
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Transperineal template-guided saturation prostate biopsy. (A) Patient positioning, (B) size measurement and setting, (C) systemic biopsies via a standard brachytherapy grid, and (D) sagittal view of longitudinal biopsy.

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  Fig. 2 Association between Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) score and results of transperineal template-guided saturation prostate biopsy (TPB) in males with a previous negative result on transrectal ultrasound (TRUS)-guided biopsy or who were candidates for active surveillance. mpMRI, multiparametric magnetic resonance imaging.

• 

  Fig. 3 Treatment strategy for patients with active surveillance (AS) according to transperineal template-guided saturation prostate biopsy (TPB). GS, Gleason score.

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