title: Predictors of prostate cancer in ultrasound-guided transperineal saturation biopsy in Turkish men with multiple prior negative biopsies.
abstract: BACKGROUND
  Transperineal prostate biopsy (STPB) is associated with an improved cancer detection rate and an increase in anterior and apical prostate cancers compared to standard transrectal biopsy.
  
  
  METHODS
  A total of 48 men with at least two sets of prior prostate biopsies underwent transrectal ultrasound-guided STPB. Prostate rebiopsy indications were serum prostate-specific antigen (PSA) levels greater than 2.5 ng/mL and/or abnormal digital rectal examination and/or presence of high-grade prostatic intraepithelial neoplasia (HGPIN; ≥2 cores) or atypical small acinar proliferation (ASAP) at previous biopsies. The procedure was performed at dorsal lithotomy position under general anesthesia using a perineal 0.5 cm brachytherapy template attached to the transrectal ultrasound probe. Specimens from each zone were sent separately for pathological examination.
  
  
  RESULTS
  Mean PSA level at STPB was 15.9 ng/mL (range 4.03 to 59.57). An average of 54.5 cores was obtained. Prostate adenocarcinoma was detected in 15 of 48 (31%) patients. Mean percentage of malignant cores was 11.9%. Multivariate logistic regression analysis revealed that age and presence of ASAP or HGPIN at previous biopsies were independent predictors of prostate cancer (p&lt;0.05). No major complications, including sepsis and severe urinary or rectal bleeding, were observed in any of the patients. Five patients (10%) developed acute urinary retention after the procedure requiring urethral catheterization.
  
  
  CONCLUSIONS
  Considerable number of patients with negative multiple biopsies were diagnosed with prostate cancer. STPB is a well-tolerated procedure with minimal morbidity, which can be considered for the diagnosis of prostate cancer in patients with previous negative biopsies.
authors.affiliation: Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey.
authors.forename: Sertac
authors.initials: S
authors.lastname: Yazici
authors.affiliation: Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey.
authors.forename: Halil
authors.initials: H
authors.lastname: Kiziloz
authors.affiliation: Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey.
authors.forename: Ali Cansu
authors.initials: AC
authors.lastname: Bozaci
authors.affiliation: Department of Pathology, Hacettepe University School of Medicine, Ankara - Turkey.
authors.forename: Dilek Ertoy
authors.initials: DE
authors.lastname: Baydar
authors.affiliation: Department of Urology, San Bassiano Hospital, Bassano del Grappa (Vicenza) - Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Del Biondo
authors.affiliation: Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey.
authors.forename: Haluk
authors.initials: H
authors.lastname: Ozen
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D014421:Turkey; D018084:Ultrasonography, Interventional