Transperineal Prostate Biopsy Improves the Detection of Clinically Significant Prostate Cancer among Men on Active Surveillance

Abstract

No AccessJournal of UrologyAdult Urology1 Apr 2021Transperineal Prostate Biopsy Improves the Detection of Clinically Significant Prostate Cancer among Men on Active SurveillanceThis article is commented on by the following:Editorial Comment Alexa R. Meyer, Mufaddal Mamawala, Jared S. Winoker, Patricia Landis, Jonathan I. Epstein, Katarzyna J. Macura, Mohamad E. Allaf, Alan W. Partin, Christian P. Pavlovich, and Michael A. Gorin Alexa R. MeyerAlexa R. Meyer *Correspondence: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Marburg 134, Baltimore, Maryland 21287 telephone: [phone]; E-mail Address: [email protected] James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Mufaddal MamawalaMufaddal Mamawala James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Jared S. WinokerJared S. Winoker James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Patricia LandisPatricia Landis James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Jonathan I. EpsteinJonathan I. Epstein Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Katarzyna J. MacuraKatarzyna J. Macura James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland , Mohamad E. AllafMohamad E. Allaf James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Alan W. PartinAlan W. Partin James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , Christian P. PavlovichChristian P. Pavlovich James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland , and Michael A. GorinMichael A. Gorin James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland View All Author Informationhttps://doi.org/10.1097/JU.0000000000001523AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Transperineal prostate biopsy offers improved sampling of the anterior prostate compared to the transrectal approach. The objective of this study was to determine if transperineal prostate biopsy is associated with an increased incidence of cancer upgrading among men on active surveillance for very low or low risk prostate cancer. Materials and Methods: Our active surveillance registry was queried to identify patients who underwent a surveillance biopsy following the introduction of transperineal prostate biopsy at our institution. Patients were dichotomized by the type of biopsy performed. The baseline characteristics and rates of cancer upgrading were compared between groups. Results: Between November 2017 and June 2020, 790 men with very low or low risk prostate cancer underwent a surveillance biopsy. In total, 59 of 279 men (21.2%) in the transperineal prostate biopsy group were upgraded to grade group ≥2 as compared to 75 of 511 (14.7%) in the transrectal biopsy group (p=0.01). Among patients who were upgraded to grade group ≥2, 26 of 59 (44%) had grade group ≥2 detected in the anterior/transition zone with transperineal prostate biopsy compared to 14 of 75 (18.7%) with transrectal biopsy (p=0.01). Additionally, 17 of 279 men (6.1%) who underwent transperineal prostate biopsy were upgraded to grade group ≥3 vs 17 of 511 (3.3%) who underwent transrectal biopsy (p=0.05). After adjusting for age, prostate specific antigen density, use of magnetic resonance imaging, and number of prior transrectal biopsies, transperineal prostate biopsy was significantly associated with upgrading to grade group ≥2 (OR 1.49, 95% CI 1.11–2.19, p=0.01). Conclusions: Among men on active surveillance for very low or low risk prostate cancer, transperineal prostate biopsy was associated with an increased likelihood of upgrading to clinically significant prostate cancer. This is likely due to improved sampling of the anterior prostate with the transperineal approach. References 1. : Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190: 419. Link, Google Scholar 2. : An update of the American Urological Association white paper on the prevention and treatment of the more common complications related to prostate biopsy. J Urol 2017; 198: 329. 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Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByKim M, Wu S, Lin S, Crotty R, Harisinghani M, Feldman A, Wu C and Dahl D (2021) Transperineal Multiparametric Magnetic Resonance Imaging–Ultrasound Fusion Targeted Prostate Biopsy Combined with Standard Template Improves Prostate Cancer DetectionJournal of Urology, VOL. 207, NO. 1, (86-94), Online publication date: 1-Jan-2022.Smith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 205, NO. 4, (951-952), Online publication date: 1-Apr-2021.Related articlesJournal of UrologyJan 25, 2021, 12:00:00 AMEditorial Comment Volume 205Issue 4April 2021Page: 1069-1074 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmswatchful waitingbiopsyprostateMetricsAuthor Information Alexa R. Meyer James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland *Correspondence: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Marburg 134, Baltimore, Maryland 21287 telephone: [phone]; E-mail Address: [email protected] More articles by this author Mufaddal Mamawala James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Jared S. Winoker James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Patricia Landis James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Jonathan I. Epstein Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Katarzyna J. Macura James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Mohamad E. Allaf James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Alan W. Partin James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Christian P. Pavlovich James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Michael A. Gorin James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland Financial interest and/or other relationship with Perineologic. More articles by this author Expand All Advertisement Loading ...