title: CT-Guided Transgluteal Biopsy for Systematic Random Sampling of the Prostate in Patients Without Rectal Access.
abstract: OBJECTIVE
  The objective of our study was to review our experience with CT-guided transgluteal prostate biopsy in patients without rectal access.
  
  
  METHODS
  Twenty-one CT-guided transgluteal prostate biopsy procedures were performed in 16 men (mean age, 68 years; age range, 60-78 years) who were under conscious sedation. The mean prostate-specific antigen (PSA) value was 11.4 ng/mL (range, 2.3-39.4 ng/mL). Six had seven prior unsuccessful transperineal or transurethral biopsies. Biopsy results, complications, sedation time, and radiation dose were recorded. The mean PSA values and number of core specimens were compared between patients with malignant results and patients with nonmalignant results using the Student t test.
  
  
  RESULTS
  The average procedural sedation time was 50.6 minutes (range, 15-90 minutes) (n = 20), and the mean effective radiation dose was 8.2 mSv (median, 6.6 mSv; range 3.6-19.3 mSv) (n = 13). Twenty of the 21 (95%) procedures were technically successful. The only complication was a single episode of gross hematuria and penile pain in one patient, which resolved spontaneously. Of 20 successful biopsies, 8 (40%) yielded adenocarcinoma (Gleason score: mean, 8; range, 7-9). Twelve biopsies yielded nonmalignant results (60%): high-grade prostatic intraepithelial neoplasia (n = 3) or benign prostatic tissue with or without inflammation (n = 9). Three patients had carcinoma diagnosed on subsequent biopsies (second biopsy, n = 2 patients; third biopsy, n = 1 patient). A malignant biopsy result was not significantly associated with the number of core specimens (p = 0.3) or the mean PSA value (p = 0.1).
  
  
  CONCLUSIONS
  CT-guided transgluteal prostate biopsy is a safe and reliable technique for the systematic random sampling of the prostate in patients without a rectal access. In patients with initial negative biopsy results, repeat biopsy should be considered if there is a persistent rise in the PSA value.
authors: 1 Department of Radiology, Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195.
authors: Ajit H
authors: AH
authors: Goenka
authors: 1 Department of Radiology, Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195.|2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Erick M
authors: EM
authors: Remer
authors: 1 Department of Radiology, Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195.
authors: Joseph C
authors: JC
authors: Veniero
authors: 1 Department of Radiology, Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195.|3 Present address: Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center, Houston, TX.
authors: Chakradhar R
authors: CR
authors: Thupili
authors: 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Eric A
authors: EA
authors: Klein
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002081:Buttocks; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011829:Radiation Dosage; D015641:Radiography, Interventional; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: CT guidance; prostate biopsy; prostate cancer; prostate-specific antigen (PSA)