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2008 Annual Meeting Abstracts
Initial Experience with Transperineal Saturation Prostate Biopsies in Patients with Previous Negative Transrectal Prostate Biopsies
Mini Varghese, Jennifer Simmons, John Danella, Daniel B Rukstalis
Geisinger Health System, Danville, PA
Introduction: Saturation prostate biopsy (SPB) represents an evolution of the prostate biopsy paradigm. Rising prostate-specific antigen (PSA) levels after negative transrectal prostate biopsies remain a clinical problem for urologists. We conceptualize the prostate to have twelve zones (apex, mid, and base with anterior and posterior divisions) and have developed a transperineal template-guided process to better sample the anterior prostate.
Methods: SPB was conducted under general anesthesia with patient in lithotomy position. An ALOKA SSD-4000 ultrasound unit with a biplanar endorectal linear array transducer was used with a CIVCO stepper and brachytherapy grid stabilizing arm. Biopsies were obtained from each of the twelve prostate zones.
Results: Thirty-two patients underwent transperineal SPBs between June 2006 and March 2008. Prostate cancer was identified in sixteen patients: one had Gleason 8, two had Gleason 7, and thirteen had Gleason 6. Nine patients had exclusively anterior cancer; four had exclusively posterior cancer. Two patients experienced urinary retention requiring catheterization.
Conclusions: In patients with negative transrectal prostate biopsies and rising PSA levels, concern remains for the presence of prostate cancer. Our experience demonstrates that transperineal SPBs have a 50% yield in finding cancer in this heavily biopsied population. In 56% of positive cases, detection resulted from improved sampling of anterior prostate tissue. Transperineal template-guided SPB is a procedure with low morbidity that improves diagnosis of anterior-based prostate cancer.
Patient parameters at time of Transperineal Saturation Prostate Biopsy| Parameter | Median | Range | | Age | 61 | 48-75 | | Pre-procedure PSA (ng/mL) | 9.68 | 2.16-65.21 | | Number of previous negative prostate biopsies | 2 | 1-9 | | Number of cores taken during previous prostate biopsies | 13 | 12-26 | | Prostate volume at time of saturation prostate biopsy | 40.1 | 23-104 | | Number of cores taken during saturation prostate biopsy | 51 | 17-91 |
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