Date post: | 20-Feb-2017 |
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Transperineal BiopsyGaining more interest.
2 (-ve) TRUS2 (-ve) TRUS(↑↑) PSA(↑↑) PSA
122122
4040 68%68%
58%58%
2011
Hypothesis
Transperineal biopsy is better than TRUS
biopsy in detection of prostate cancer.
PSA is better biomarker than we thought.
Prospective studyTRUS biopsy + TPTPB simultaneously Inclusion criteria:-↑↑ PSA (<20 ng/mL)-Benign DRE-No previous biopsies
Our Study
Initial power calculations 80
patients.
Repeated after 40 patients.
50 patients were sufficient.
StatisticsOur Study
TechniqueOur Study
Day case.
General anesthesia.
Ciprofloxacin 500mg.
Gentamicin 120mg + 1.2gm Co-
amoxicalv.
Technique - TPTPBOur Study
Extended lithotomy. 14F catheter is inserted.Prostate is divided into 6 sectors.
50 patients.
Age: 67 years (range: 54-84)
PSA: 8 ng/mL (range: 4-18)
Prostate Volume: 58 cc (range: 19-165)
ResultsAugust 2012 - August 2013
(+ve) TPTPB
(-ve) TPTPB
(+ve) TRUS 16 (32%) 0(-ve) TRUS 14 (28%) 20 (40%)
Results
20 Benign.30 Cancers.
Cancer Detection RatesWhole Cohort (n=50)
ResultsCancer Detection Rates
TRUS p<0.0001 TPTPB
16 Cancer 30
6 G3+3 116 G3+4 143 G4+3 31 G4+5 234 Benign 20
19 HGPIN 810 Atypia 85 Benign 4
32%32% 60%60%
Whole Cohort (n=50)
TRUS p<0.0001 TPTPB
16 Cancer 30
6 G3+3 116 G3+4 143 G4+3 31 G4+5 2
ResultsCancer Detection Rates
32%32% 60%60%
Whole Cohort (n=50)
TRUS p<0.0001 TPTPB
16 Cancer 30
6 G3+3 116 G3+4 14
3 G4+3 3
1 G4+5 2
ResultsCancer Detection Rates
32%32% 60%60%
Whole Cohort (n=50)
The majority is ≥ Gleason 7No “over diagnosis”
63%63%63%63%
TRUS TPTPB
- Cancer 14
- G3+3 6- G3+4 7
- G4+3 1
- G4+5 0
ResultsCancer Detection RatesCancers missed by TRUS in 28% of patients
(n=14)
26% (8/30) of patients diagnosed with cancer would have been missed by TRUS and would have Gleason 7.
57%57%
ResultsCancer Detection Rates
TRUS p<0.0.2 TPTPB
16 Cancer 30
6 G3+3 116 G3+4 143 G4+3 31 G4+5 234 Benign 20
19 HGPIN 810 Atypia 85 Benign 4
31%31% 59%59%
PSA ≤10 ng/mL (n=39)
ResultsCancer Detection Rates
TRUS p<0.0.2 TPTPB
16 Cancer 30
6 G3+3 116 G3+4 143 G4+3 31 G4+5 234 Benign 20
19 HGPIN 810 Atypia 85 Benign 4
34%34% 63%63%
Prostate Volume <50 cc (n=32)
ResultsCancer Detection Zones in TPTPB
226/1800 (+ve) cores (12.5%)
Zone Percentage (%)
Anterior 92 40
Middle 68 31
Posterior 66 29
Complications
Complications Number Percentage (%)
AUR 7 14
Urospesis 2 4
Hematuria 16 32
PR Bleeding 8 16
Hematospermia 16 32
Ecchymosis 15 30
General anesthetic.
Pubic arch interference (large prostates).
Urine retention (14%).
Right number of biopsies?
Limitations of TPTPB