title: CT-guided transgluteal biopsy for systematic sampling of the prostate in patients without rectal access: a 13-year single-center experience.
abstract: OBJECTIVE
  The purpose of our study was to examine the safety and diagnostic utility of transgluteal CT-guided prostate biopsy for prostate sampling in patients without rectal access.
  
  
  METHODS
  Seventy-three biopsies were performed in 65 patients over a 13-year period (2002-2015). Mean prostate-specific antigen (PSA) at biopsy was 7.8 ng/mL (range 0.37-31.5). Electronic medical records were reviewed for procedural details and complications. Mean PSA and number of cores in malignant and benign cohorts were compared with Student's t test.
  
  
  RESULTS
  Technical success rate was 97.3% (71/73; mean cores 8, range 3-28). Of these, 43.6% (31/71) yielded malignancy (mean Gleason score 7, range 6-10) and 56.3% (40/71) yielded benign tissue. The only complication was an asymptomatic periprostatic hematoma (1/73; 1.4%). In 14 patients who underwent surgery, Gleason scores were concordant in 71.4% (10/14) and discordant in 28.6% (4/14; Gleason 6 on biopsy but Gleason 7 on surgical specimen). Mean effective radiation dose was 18.5 mSv (median 15.0, range 4.4-86.2). There was no significant difference in either mean PSA (p = 0.06) or number of core specimens (p = 0.33) between malignant and benign cohorts.
  
  
  CONCLUSIONS
  CT-guided transgluteal prostate biopsy is highly safe and reliable for the detection of prostate cancer in men without rectal access.
  
  
  CONCLUSIONS
  • Prostate cancer detection in men without rectal access is challenging. • CT-guided transgluteal prostate biopsy is safe and effective in these patients. • CT-guided biopsy may be particularly effective in diagnosing high-grade prostate cancer. • Unilateral CT-guided biopsy may be effective in patients with focal lesions. • The radiation exposure with this technique is acceptable.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. olson.michael2@mayo.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Olson
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Atwell
authors.affiliation: Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Bernard F
authors.initials: BF
authors.lastname: King
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Welch
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Ajit H
authors.initials: AH
authors.lastname: Goenka
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002081:Buttocks; D000075204:Contraindications, Procedure; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D015641:Radiography, Interventional / Q000379:methods; D012007:Rectum; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Anorectal anomalies; Image-guided biopsy; Prostate; Prostate cancer; Prostate-specific antigen