Transperineal saturation prostate biopsy in treated and untreated patients

The purpose of the current study was to assess the diagnostic value of transperineal saturation prostate biopsy in diagnosing false-negative cases by transrectal ultrasound-guided biopsies (TRUSG) in treated and untreated patients. Forty-eight patients with median age 62.5 years (range: 44-85) who underwent transperineal saturation biopsy after previous negative TRUSG biopsies between July 2002 and March 2011 were included. Thirty-one were primary cases (untreated) and 17 patients (treated) have received radiotherapy or cryotherapy. The median values of prostate-specific antigens before saturation biopsy were 5 ng/ml and 9 ng/ml for treated and untreated patients respectively (p=0.01). The median number of cores at saturation biopsy in treated and untreated patients was 60 (range: 22-104) and 54 (range: 24-110) respectively (p=0.22). Results of transperineal biopsy with respect to diagnostic value, Gleason score, number of positive cores, and volume of cancer, location of positive cores, pathologic stage and morbidity of saturation biopsy were evaluated. Twenty three patients (47.92%) were positive for prostate cancer; 10 (58.82%) in treated and 13 (41.93%) from untreated patients (p=0.26). Gleason scores were ≥ 7 in 19 patients (82.60%). Eleven patients (47.82%) underwent radical prostatectomy. The pathological stages at pathologic specimens were T2b in 6 patients, T2a in 2, T3a in 2 and T3b in 1. Three patients (6.25%) had complications in terms of urinary retention and urosepsis. In conclusion, transperineal saturation biopsy is a useful diagnostic tool in treated and untreated patients with persistent suspicious of prostate cancer after previous negative transrectal biopsies. Transperineal saturation prostate biopsy detected clinically significant cancer with modest complication rate.