PURPOSE: To determine the incidence of cancer detection with transperineal template-guided mapping biopsy (TTMB) of the prostate in patients having at least one previously negative transrectal ultrasound-guided (TRUS) biopsy.
MATERIALS AND METHODS: From January 2005 - January 2012, 485 patients in our clinical database had undergone at least one negative TRUS biopsy prior to proceeding with TTMB. None of the study patients had previous prostate cancer diagnosis. The percentage of patients with 1, 2 or = 3 previous TRUS biopsies were 55.3%, 25.9% and 18.8%, respectively. The majority of patients (74.8%) underwent TTMB for rising (or occasionally persistently elevated) PSA and the remainder for either atypical small acinar proliferation (19.4%) or high-grade prostatic intraepithelial neoplasia (5.8%).
RESULTS: For the entire study population, a median number of 59 cores were submitted at the time of TTMB. Cancer was ultimately detected in 226 (46.6%) of the patients using TTMB. This included 196 (86.7%) with clinically significant disease according to the Epstein criteria. The most common location of cancer detection on TTMB was the anterior apex.
CONCLUSIONS: In this study, TTMB detected clinically significant prostate cancer in a substantial proportion of patients with negative TRUS biopsy. TTMB should be strongly considered in the context of a rising PSA with failed confirmation of tissue diagnosis.
Written by:
Bittner N, Merrick GS, Butler WM, Bennett A, Galbreath RW. Are you the author?
Tacoma/Valley Radiation Oncology Centers, Tacoma, WA.
Reference: J Urol. 2013 Feb 14. pii: S0022-5347(13)00290-5.
doi: 10.1016/j.juro.2013.02.021
PubMed Abstract
PMID: 23416641
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