title: Location and pathological characteristics of cancers in radical prostatectomy specimens identified by transperineal biopsy compared to transrectal biopsy.
abstract: OBJECTIVE
  Anterior tumors are estimated to constitute 20% of prostate cancers. Current data indicate that transperineal biopsy is more reliable than transrectal biopsy in identifying these tumors. If correct, this superior reliability should result in an increased proportion of anterior tumors identified by transperineal biopsy. We investigated this hypothesis with reference to prostatectomy specimens.
  
  
  METHODS
  Radical prostatectomy histopathology records were retrospectively examined. Patients were grouped based on primary transperineal or transrectal biopsy as the modality used to identify the initial cancer. After grouping, tumor location and size were recorded and, thus, the proportion of anterior tumors was determined.
  
  
  RESULTS
  A total of 1,132 (414 transperineal and 718 transrectal) prostatectomy specimens were examined. Overall mean tumor size (1.8 and 2.0 cm(3)), stage (pT2 63.3% and 61%) and significance (5.1% and 5.1%) for the transperineal and transrectal methods were similar. However, the transperineal method was associated with proportionally more anterior tumors (16.2% vs 12%, p = 0.046), and identified them at a smaller size (1.4 vs 2.1 cm(3), p = 0.03) and lower stage (extracapsular extension 13% vs 28%, p = 0.03) compared to the transrectal method. The pT3 positive surgical margin rate for anterior vs other tumors was 69% vs 34.9%, respectively.
  
  
  CONCLUSIONS
  Overall transrectal and transperineal biopsy identify cancers that are similar in size, stage and significance. However, transperineal biopsy detected proportionally more anterior tumors (16.2% vs 12%), and identified them at a smaller size (1.4 vs 2.1 cm(3)) and stage (extracapsular extension 13% vs 28%) compared to transrectal biopsy. Identifying anterior tumors early is important because the positive surgical margin rate for anterior pT3 lesions is significantly higher.
authors: Department of Urology, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia.
authors: Tania
authors: T
authors: Hossack
authors: Manish I
authors: MI
authors: Patel
authors: Andrew
authors: A
authors: Huo
authors: Phillip
authors: P
authors: Brenner
authors: Carlo
authors: C
authors: Yuen
authors: Daniel
authors: D
authors: Spernat
authors: Jayne
authors: J
authors: Mathews
authors: Anne-Marie
authors: AM
authors: Haynes
authors: Rob
authors: R
authors: Sutherland
authors: Warick
authors: W
authors: del Prado
authors: Phillip
authors: P
authors: Stricker
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D008297:Male; D010502:Perineum; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012007:Rectum; D012189:Retrospective Studies