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Abstract

Volume 26, Issue 4 (July 2024) 26, 377–381; 10.4103/aja20241

Transrectal versus transperineal prostate biopsy for cancer detection in patients with gray-zone prostate-specific antigen: a multicenter, real-world study

Liu, Jun-Xiao1,2,*; Wang, Ze-Yuan3,*; Niu, Shao-Xi4; Sai, Xiao-Yong5; Zhang, Xu2; Zhang, Xue-Pei3; Ma, Xin2

1The Graduate School, Chinese PLA General Hospital, Beijing 100853, China
    
    2Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    
    3Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    
    4Department of Urology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    
    5Faculty of Epidemiology and Statistics, The Graduate School, Chinese PLA General Hospital, Beijing 100853, China

Correspondence: Dr. X Ma (mxin301@126.com) or Dr. XP Zhang (zhangxuepei@263.net)

16 April 2024

Abstract

Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate (CDR) in patients with gray-zone prostate-specific antigen (PSA) is limited. We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone. Two hundred and twenty-two patients who underwent transrectal prostate biopsy (TRB) and 216 patients who underwent transperineal prostate biopsy (TPB) between June 2016 and September 2022 were reviewed in this study. In addition, 110 patients who received additional targeted biopsies following the systematic TPB were identified. Clinical parameters, including age, PSA derivative, prostate volume (PV), and needle core count, were recorded. The data were fitted via propensity score matching (PSM), adjusting for potential confounders. TPB outperformed TRB in terms of the CDR (49.6% vs 28.3%, P = 0.001). The clinically significant prostate cancer (csPCa) detection rate was not significantly different between TPB and TRB (78.6% vs 68.8%, P = 0.306). In stratified analysis, TPB outperformed TRB in CDR when the age of patients was 65–75 years (59.0% vs 22.0%, P < 0.001), when PV was 25.00–50.00 ml (63.2% vs 28.3%, P < 0.001), and when needle core count was no more than 12 (58.5% vs 31.5%, P = 0.005). The CDR (P = 0.712) and detection rate of csPCa (P = 0.993) did not significantly differ among the systematic, targeted, and combined biopsies. TPB outperformed TRB in CDR for patients with gray-zone PSA. Moreover, performing target biopsy after systematic TPB provided no additional benefits in CDR.

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.