Transperineal BiopsyGaining more interest.

2 (-ve) TRUS2 (-ve) TRUS(↑↑) PSA(↑↑) PSA4040 68%68%

2011

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 – TRUS BiopsyOur Study

Left lateral position.Sextant 12-core TRUS biopsy.

Technique - TPTPBOur Study

Extended lithotomy. 14F catheter is inserted.Prostate is divided into 6 sectors.

Technique - TPTPBOur Study

6 biopsies taken from each sector.Catheter is removed.

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)

TRUS TPTPB

p < 0.0001

16/50 30/50

ResultsCancer Detection Rates

Whole 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

Conclusions

TPTP the new gold standard.

PSA is a better biomarker than we

thought.

Thank You