ABSTRACT: Anterior tumors are estimated to constitute 20% of prostate cancers. Current data indicate that transperineal biopsy is more reliable than transrectal biopsy in identifying these tumors. If correct, this superior reliability should result in an increased proportion of anterior tumors identified by transperineal biopsy. We investigated this hypothesis with reference to prostatectomy specimens.
Radical prostatectomy histopathology records were retrospectively examined. Patients were grouped based on primary transperineal or transrectal biopsy as the modality used to identify the initial cancer. After grouping, tumor location and size were recorded and, thus, the proportion of anterior tumors was determined.
A total of 1,132 (414 transperineal and 718 transrectal) prostatectomy specimens were examined. Overall mean tumor size (1.8 and 2.0 cm(3)), stage (pT2 63.3% and 61%) and significance (5.1% and 5.1%) for the transperineal and transrectal methods were similar. However, the transperineal method was associated with proportionally more anterior tumors (16.2% vs 12%, p = 0.046), and identified them at a smaller size (1.4 vs 2.1 cm(3), p = 0.03) and lower stage (extracapsular extension 13% vs 28%, p = 0.03) compared to the transrectal method. The pT3 positive surgical margin rate for anterior vs other tumors was 69% vs 34.9%, respectively.
Overall transrectal and transperineal biopsy identify cancers that are similar in size, stage and significance. However, transperineal biopsy detected proportionally more anterior tumors (16.2% vs 12%), and identified them at a smaller size (1.4 vs 2.1 cm(3)) and stage (extracapsular extension 13% vs 28%) compared to transrectal biopsy. Identifying anterior tumors early is important because the positive surgical margin rate for anterior pT3 lesions is significantly higher.
The Journal of urology 07/2012; 188(3):781-5. · 4.02 Impact Factor
ABSTRACT: We determined whether systematic template guided transperineal biopsies can accurately locate and sensitively detect prostate cancer. In addition, we reported discrepancies between diagnostic and pathological Gleason scores, and investigated whether prostate size had an effect on the cancer detection rate.
This retrospective diagnostic accuracy study compares the results of primary transperineal biopsies with the radical prostatectomy pathology of 414 consecutive patients treated at a single institution between November 2002 and August 2010.
The average sensitivity and specificity for the detection of cancer in all prostates across all biopsy zones was 48% (95% CI 42.6-53.4) and 84.1% (95% CI 80-88.2), respectively. There was a statistically significant decrease in the sensitivity of transperineal biopsy in larger prostates (t11=4.687, p=0.001). The overall Kappa value was 0.255 (95% CI 0.212-0.298). Grading concordance between biopsy and pathology specimens was achieved in 65.7% of patients. Upgrading of Gleason scores occurred in 25.6% of patients and downgrading occurred in 8.8%.
Our current transperineal biopsy method has only demonstrated fair agreement with the histopathology findings of the corresponding radical prostatectomy specimens. This finding is most likely due to the small, multifocal nature of prostate cancer in the patient series. The cancer detection rate was lower in larger prostates. Thus, clinicians may consider increasing the number of cores in larger prostates as a strategy to improve cancer detection.
The Journal of urology 04/2012; 187(6):2044-9. · 4.02 Impact Factor
ABSTRACT: To report the first long-term experience on the efficacy of bipolar transurethral radiofrequency needle ablation (RFA) in patients with lower urinary tract symptoms that are secondary to benign prostatic hyperplasia.
A nonrandomized prospective cohort of 12 candidates for transurethral resection of the prostate underwent bipolar transurethral RFA in 2004 (mean age 63; prostate volume 34 cc). Patients were evaluated preoperatively and at 3, 12, 36, and 60 months postprocedure. International Prostate Symptom Score (IPSS), quality-of-life (QoL) index, peak urinary flow rate (Qmax), postvoid residual volume (PVR), and need for a second procedure were evaluated at each follow-up interval.
Significant improvement in urinary symptoms and voiding parameters occurred at 1 year after the procedure. Mean improvements for IPSS, QoL, and Q(max) were 12 points, 3.5 points, and 8 mL/s, respectively. Improvement, however, was not sustained in the long term. Nine patients ultimately had treatment failure necessitating a secondary procedure, one at 2 months, five after 3 years, and three by 5 years. Two patients were lost to follow-up. Only one patient had long-term benefit from the procedure.
In the short term, bipolar RFA produced clinically meaningful improvement in symptom scores and voiding parameters. The majority of patients, however, eventually experienced treatment failure and needed additional surgical procedures. Only 8% of patients had long-term (>5 years) benefit.
Journal of endourology / Endourological Society 05/2011; 25(5):837-40. · 1.75 Impact Factor
ABSTRACT: • To measure patient discomfort associated with transrectal ultrasonography guided prostate biopsy (TRUSPB) performed with periprostatic local anaesthetic (LA) infiltration and to document agreement to possible repeat biopsy, as a recent audit showed that 86% of Australian urologists performed prostate biopsies using sedation or general anaesthesia (GA), which implies many urologists think patients are unwilling to tolerate the procedure under LA block and/or may refuse a repeat procedure.
• This was a prospective cohort study following all men undergoing TRUSPB in 2008. • Immediately after the procedure the men were asked to complete a visual analogue pain score. • They were then asked whether, if it was necessary to have a repeat biopsy, they would agree to LA again or request GA/sedation.
• In all, 476 men participated in the study with a mean age of 64 years. • Of these, 464 men (97.5%) tolerated the procedure well and would, if required, agree to repeat biopsy with LA. • Only 12 men (2.5%) indicated they would request GA/sedation if a repeat biopsy was necessary.
• The vast majority of men accepted having prostate biopsy with LA infiltration and therefore this should be the first method offered. • It may be possible to screen for men who would not tolerate biopsy under LA. • Resource saving by performing most biopsies under LA can be estimated to be >A$10 million annually.
BJU International 04/2011; 107 Suppl 3:38-42. · 2.84 Impact Factor