Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients

Comparison of the incidence of clinically significant prostate cancer in patients with isolated peripheral versus transitional zone PIRADS 3 lesions

INTRODUCTION

We sought to investigate the association between isolated PIRADS 3 lesions of the transitional zone (TZ) versus the peripheral zone (PZ) and the incidence of clinically significant prostate cancer (csPCa) on systematic and targeted prostate biopsy (SB, TB).

METHODS

We retrospectively reviewed our tertiary institutional database of patients who underwent mpMRI-fusion followed by TB + SB between 2016 and 2021. We compared the incidence of csPCa (Gleason Grade Group ⩾ 2) in patients with solitary TZ-only PIRADS 3 and PZ-only PIRADS 3 on SB and TB. We excluded patients with (1)known PCa, (2)PIRADS 4-5 and/or (3)lesions in both TZ and PZ. T-tests, Chi-square tests, were conducted to compare between the groups.

RESULTS

Of 1913 patients, we identified 110 with PZ-only and 38 with TZ-only PIRADS 3 lesions. 73 patients in PZ-only and 19 in TZ-only met inclusion criteria. No statistically significant differences were observed between PZ and TZ groups in terms of age, median prostate-specific antigen (PSA), prostate volume, median PSA-density, or median number of targeted cores obtained, all with p > 0.05.On SB, the incidence of csPCA was higher in patients with PZ rather than TZ PIRADS-3 lesions (10/73 vs 1/19, p = 0.28). Similarly, csPCA was more common in TB of PZ versus TZ PIRADS 3 lesions (7/73 vs 0/19, p = 0.33). Based on these results, the positive predictive values of PIRADS3 as a marker of csPCA were 5.3% and 0% for TZ lesions on SB versus TB, respectively, compared to 17.7% and 9.6% in the PZ.

CONCLUSIONS

PIRADS 3 lesions are rarely associated with csPCA on SB and TB, particularly when located in the TZ, which is an important factor to consider when deciding on a biopsy in patients with isolated TZ lesions.

Comparing the Efficacy and Safety of the Transperineal Versus Transrectal Prostate Biopsy Approach in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate cancer (PCa) has high prevalence rates in men and is a leading cause of cancer-related death. Transrectal (TR) biopsy has traditionally been the gold standard for diagnosis, but transperineal (TP) biopsy is increasingly favoured due to its lower infection risk. However, debate remains regarding which method has superior cancer detection rates. This review compares the efficacy and safety of the TP as compared to the TR prostate biopsy approach, summarizing the largest body of evidence available to date. A literature search was performed on the PubMed, Google Scholar, Cochrane Library, and Embase databases. We searched from the inception of the databases up to August 2024 for relevant studies comparing the cancer detection rate of TP versus TR prostate biopsy and compared their complication rates. Twenty-one studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences between the TR and TP groups in the PCa detection rate. This meta-analysis included 21 studies (6 randomized control trials and 15 cohort studies) with a total of 13,818 patients (TP = 7917; TR = 5901), who were accrued between 2008 and 2024 and divided into the TR group and the TP group. The analysis revealed no significant difference in prostate cancer detection rates between the TP and TR approaches in both RCTs (OR 1.02, 95% CI (0.74, 1.41), p = 0.90) and cohort studies (OR 1.07, 95% CI (0.85, 1.35), p = 0.36). Complication profiles were largely comparable; TP demonstrated a significantly lower risk of urinary tract infections (OR 0.26, 95% CI (0.11, 0.61)) but no notable differences in acute urinary retention, haematuria, or rectal bleeding. Our findings advocate the TP approach as a safer biopsy alternative where feasible, particularly in infection-sensitive populations, without compromising diagnostic accuracy. MRI should complement biopsy strategies to enhance diagnostic precision. Future research should focus on standardized, large-scale RCTs to further refine and personalize prostate cancer diagnostic pathways.

Outcomes of Systematic Transrectal Ultrasound-Guided Prostate Biopsy Performed by a Surgical Care Practitioner and Implications for Resource-Poor Countries

Introduction Prostate cancer remains the most prevalent cancer among men and continues to present a significant public health challenge globally. The disease's growing prevalence has heightened the demand for skilled professionals capable of obtaining histological samples for accurate diagnosis, as tissue biopsy remains the cornerstone for diagnosing prostate cancer. Surgical care practitioners have become integral to the surgical team, and their roles have expanded to include performing biopsies. This paper evaluates the outcomes of transrectal ultrasound-guided (TRUS) prostate biopsies conducted by a surgical care practitioner (SCP) and explores the implications for resource-poor countries. Methods We retrospectively collated data from 218 patients who underwent TRUS prostate systematic biopsy by a surgical care practitioner between 2020 and 2022. We evaluated the prostate-specific antigen (PSA) values, MRI Likert score where available, and histological data and determined diagnostic yield and complication rates. Results The mean age and PSA level of the men were 69.7 years and 61.2 ng/ml, respectively; an average of 12 cores were obtained per biopsy. The cancer detection rate was 128/218 (59%), with a mean Gleason grade of 2.8. From available MRI, Likert 3 was the most common finding, 45/103 (43.6%), and prostate cancer was found in 40%. The mean MRI Likert scores for a positive and negative biopsy were 4 and 3.3, respectively. We recorded three complications (1%), all Clavien-Dindo 1 to 2, with no mortality. Conclusion A well-trained, supported, and supervised surgical care practitioner can safely and effectively perform TRUS systematic prostate biopsies and may improve access to prostate cancer diagnosis in developing countries.

Transrectal oocyte retrieval for fertility preservation in virginal women

RESEARCH QUESTION

How safe and effective is transrectal oocyte retrieval (TROR) for fertility preservation in nulliparous virginal women?

DESIGN

This was a retrospective single-centre study of 105 nulliparous women from five satellite centres of Fakih IVF, UAE, who underwent TROR for oocyte cryopreservation. Extensive bowel preparation and rectal cleansing was performed prior to oocyte retrieval. Patient characteristics, stimulation protocol, and procedure outcome and safety data were collected. Correlation analyses of the number of follicles and oocyte yield in relation to age and anti-Müllerian hormone (AMH) concentration, and the number of follicles in relation to oocyte yield were performed.

RESULTS

This study evaluated 105 patients who underwent 152 cycles of ovarian stimulation and TROR. The most common indication was social fertility preservation. A significant positive correlation was found between the AMH concentration and number of oocytes (r = 0.83, P < 0.003). No intra-operative or postoperative complications were observed.

CONCLUSION

This study demonstrated that TROR is an alternative and clinically effective oocyte harvesting procedure in assisted reproductive technology, producing good results in terms of oocyte yield, with no complications and a good safety profile. Although transvaginal oocyte retrieval remains the gold-standard treatment, TROR is safe and effective for virginal women in whom transvaginal oocyte retrieval is not an option.

Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates

Objectives

We conducted a systematic review to compare the diagnostic utility of ultrasound-guided transperineal (TP) and transrectal (TR) prostate biopsy methods for prostate cancer detection.

Methods

We searched PubMed, Embase, Web of Science, and Cochrane databases up to October 30, 2023, for relevant studies, screening the literature and assessing bias independently.

Results

Eleven trials were analyzed using relative risk and 95% confidence intervals, with no evidence of publication bias. Diagnostic rates showed no significant difference between TP and TR biopsies (mean difference [MD]: 1.03, 95% confidence interval [CI]: 0.91-1.14, P = 0.56). Prostate volume analysis also showed no significant difference (MD: -0.07, 95% CI: -0.73 to 0.59, P < 0.0001, combined effect size P = 0.83). Similarly, PSA levels were comparable between TP and TR biopsies (MD: 0.93, 95% CI: -0.44 to 2.30, P < 0.0001, combined effect size P = 0.18).

Conclusion

Both biopsy methods exhibit similar diagnostic accuracy; however, TP has a lower risk of biopsy.

Analysis of biopsy pathology and risk factors of lymph node metastasis in prostate cancer

OBJECTIVE

To explore the relationship between biopsy pathology and lymph node metastasis in patients with prostate cancer (PCa), and to identify risk factors of lymph node metastasis (LNM).

PATIENTS AND METHODS

Patients diagnosed with prostate cancer were respective screened between Jan 2015 and May 2022. Patients diagnosed PCa via 13-core ultrasound-guided biopsies and underwent radical prostatectomy and lymph node dissection were identified. The clinicopathological characteristics of the patients were recorded. Relationships between LNM and non-LNM were analyzed using chi-square and independent samples t-test. Logistic regression model was fitted to analyze the risk factors of lymph node metastases.

RESULTS

Two hundreds and fifteen patients were included, sixty-seven patients had lymph node metastasis. Gleason scores in LNM group were higher than that in non-LNM group (8.5 ± 0.9 VS 7.5 ± 1.5, p < 0.001), positive biopsy in non-LNM group was significantly lower than that in LNM group (p < 0.001), Binary logistic regression analysis indicated number of positive biopsy and number of removed lymph nodes increased the risks of LNM (odds ratio, OR = 1.28, 95% confidence interval, CI = 1.16-1.42, p < 0.001; OR = 1.11, 95% CI = 1.06-1.17, p < 0.001; respectively). Number of positive biopsy in internal gland but not external gland was significant associated with LNM (OR = 1.66, 95% CI = 1.34-2.06, p < 0.001; OR = 1.19, 95% CI = 0.88-1.61, p = 0.262; respectively). The patients with lymph nodes dissection more than 13 were about four times more likely to detect lymph node metastasis than those fewer than 13 (OR = 3.92, 95% CI = 2.10-7.33, p < 0.001).

CONCLUSIONS

The risk of lymph node metastasis increased with the number of positive prostate biopsy cores, and tumors in the internal gland were more likely to cause lymph node metastasis. In addition, lymph node metastasis was more likely to be found when the number of lymph nodes dissection was greater than 13.

Advanced prostate cancer diagnosed by bone metastasis biopsy immediately after initial negative prostate biopsy: a case report and literature review

Prostate cancer (PCa) is a prevalent male malignancy that originates in the epithelial cells of the prostate. In terms of incidence and mortality of malignant tumors in men, PCa ranks second and fifth globally and first and third among men in Europe and the United States, respectively. These figures have gradually increased in recent years. The primary modalities used to diagnose PCa include prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and prostate puncture biopsy. Among these techniques, prostate puncture biopsy is considered the gold standard for the diagnosis of PCa; however, this method carries the potential for missed diagnoses. The preoperative evaluation of the patient in this study suggested advanced PCa. However, the initial prostate puncture biopsy was inconsistent with the preoperative diagnosis, and instead of waiting for a repeat puncture of the prostate primary, we performed a biopsy of the rib metastasis, which was later diagnosed as advanced PCa.