title: The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies.
abstract: OBJECTIVE
  To determine the efficacy and safety of a standardized 36 core template-assisted transperineal biopsy technique for detecting prostate cancer in patients with previously negative transrectal ultrasonography-guided prostate biopsies and elevated prostate-specific antigen (PSA) levels.
  
  
  METHODS
  Between April 2008 to September 2010, a total of 40 patients with a mean (range) age of 63 (49-73) years, a mean (range) elevated PSA level of 21.9 (4.7-87) ng/mL and two previous sets of negative TRUS-guided prostate biopsies underwent standardized 36 core template-assisted transperineal prostate biopsies under general anaesthetic as a day case procedure. The cancer detection rate and complications for all cases were evaluated.
  
  
  RESULTS
  In total, 27 of 40 (68%) patients were found to have adenocarcinoma of the prostate, two patients (5.0%) had atypical small acinar proliferation, one had high-grade prostatic intraepithelial neoplasia (2.5%), four (10%) had chronic active inflammation and six (15%) had benign histology. Gleason scores were in the range 6-9, with a median Gleason score of 7. There were no cases of urosepsis, urinary tract infections or haematuria. A single patient experienced acute urinary retention, with a subsequent succesful trial without a catheter, and haematospermia was common, although minor.
  
  
  CONCLUSIONS
  Our standardized 36 core template-assisted transperineal prostate biopsy technique is safe and associated with a high detection rate of prostate cancer. This technique should be considered in patients with elevated PSA levels and previously negative TRUS-guided prostate biopsies.
authors: Department of Urology, University Hospitals of Leicester, Leicester General Hospital, UK. rppal@doctors.org
authors: Raj P
authors: RP
authors: Pal
authors: Muhammad
authors: M
authors: Elmussareh
authors: Malek
authors: M
authors: Chanawani
authors: Masood A
authors: MA
authors: Khan
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen