title: The Efficacy of Transrectal Ultrasound Guided Biopsy Versus Transperineal Template Biopsy of the Prostate in Diagnosing Prostate Cancer in Men with Previous Negative Transrectal Ultrasound Guided Biopsy.
abstract: OBJECTIVE
  We have previously demonstrated that transperineal template prostate biopsy (TPTPB) has a significantly higher cancer detection rate compared to transrectal ultrasound guided (TRUS) biopsy in biopsy naive men with a PSA &lt; 20 ng/mL. We, therefore, performed a prospective study to determine whether TPTPB is still superior to TRUS biopsy in the detection of prostate cancer in men with persistently elevated PSA after one previous negative set of TRUS biopsies.
  
  
  METHODS
  42 patients with a background of one previous negative set of TRUS biopsy, persistently elevated PSA (but &lt; 20 ng/mL) and benign feeling digital rectal examination (DRE) underwent simultaneous standard 12-core TRUS biopsy and 36-core TPTPB under general anaesthesia. We determined the prostate cancer detection rate between the two diagnostic modalities.
  
  
  RESULTS
  Mean age was 65 years (range: 50-75), mean prostate volume was 59 cc (range: 21-152), mean PSA is 8.3 ng/L (range: 4.4-19), mean time difference between the study and the previous TRUS biopsy was 33 months (range: 1-150) with mean PSA velocity of 0.7 ng/mL/year (range: 0-8). Out of the 42 patients, 22 (52%) had benign pathology. Of the 20 patients (48%) diagnosed with prostate cancer, 4 (10%) had positive results in both TRUS biopsy and TPTPB, 1 (2%) had positive result in TRUS biopsy with negative TPTPB, while 15 (36%) had negative TRUS biopsy with positive TPTPB. Hence, TRUS biopsy detected cancer in 5/42 (12%) patients versus (19/42) 45% detected by TPTPB (P &lt; 0.01). 13/19 (68%) of cancers detected by TPTPB had Gleason score &ge;7. A total of 82/141 (58%) of positive cores was found in the anterior zone. One patient (2%) experienced urosepsis, 2 (5%) temporary urinary retention, 14 (34%) mild haematuria and 13 (32%) haematospermia.
  
  
  CONCLUSIONS
  TPTPB still shows a significantly higher prostate cancer detection rate compared to TRUS biopsy (12% versus 45%, P &lt; 0.01) in men with a previous set of negative TRUS biopsy, persistently elevated PSA (but &lt; 20 ng/mL) and benign feeling prostate on DRE.
authors.affiliation: Department of Urology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom. shady.nafie@me.com.
authors.forename: Shady
authors.initials: S
authors.lastname: Nafie
authors.affiliation: Department of Urology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanis
authors.affiliation: Department of Urology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom.
authors.forename: Masood
authors.initials: M
authors.lastname: Khan
mesh_terms: D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010502:Perineum; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology*; D012007:Rectum
chemical_list: D017430:Prostate-Specific Antigen