title: The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance.
abstract: OBJECTIVE
  To evaluate the role of transperineal template prostate biopsies in men on active surveillance.
  
  
  METHODS
  In all, 101 men on active surveillance for prostate cancer underwent restaging transperineal template prostate biopsies at a single centre. Criteria for active surveillance were ≤75 years, Gleason ≤3+3, prostate-specific antigen (PSA) ≤15 ng/mL, clinical stage T1-2a and ≤50% ultrasound-guided transrectal biopsy cores positive for cancer with ≤10 mm of disease in a single core. The number of men with an increase in disease volume or Gleason grade on transperineal template biopsy and the number of men who later underwent radical treatment were assessed. The role of PSA and PSA kinetics were studied.
  
  
  RESULTS
  In all, 34% of men had more significant prostate cancer on restaging transperineal template biopsies compared with their transrectal biopsies. Of these men, 44% had disease predominantly in the anterior part of the gland, an area often under-sampled by transrectal biopsies. In the group of men who had their restaging transperineal template biopsies within 6 months of commencing active surveillance 38% had more significant disease. There was no correlation with PSA velocity or PSA doubling time. In total, 33% of men stopped active surveillance and had radical treatment.
  
  
  CONCLUSIONS
  Around one-third of men had more significant prostate cancer on transperineal template biopsies. This probably reflects under-sampling by initial transrectal biopsies rather than disease progression.
authors.affiliation: Frimley Park Hospital, Camberley, Surrey, UK. beayres@hotmail.com
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Ayres
authors.forename: Bruce S I
authors.initials: BS
authors.lastname: Montgomery
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Barber
authors.forename: Nicola
authors.initials: N
authors.lastname: Pereira
authors.forename: Stephen E M
authors.initials: SE
authors.lastname: Langley
authors.forename: Philippa
authors.initials: P
authors.lastname: Denham
authors.forename: Simon R J
authors.initials: SR
authors.lastname: Bott
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation*; D003937:Diagnosis, Differential; D018450:Disease Progression; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010502:Perineum; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D015203:Reproducibility of Results; D018571:Sentinel Surveillance; D006113:United Kingdom / Q000453:epidemiology