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Meta-Analysis
. 2017 Apr 4;8(14):23322-23336.
doi: 10.18632/oncotarget.15056.

Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis

Jianxin Xue  1   2 , Zhiqiang Qin  2 , Hongzhou Cai  3 , Chuanjie Zhang  4 , Xiao Li  3 , Weizhang Xu  5 , Jingyuan Wang  6 , Zicheng Xu  3 , Bin Yu  3 , Ting Xu  3 , Qin Zou  3
Affiliations
Meta-Analysis

Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis

Jianxin Xue et al. Oncotarget. .

Abstract

To systematically assess the efficacy and complications of transrectal (TR) versus transperineal (TP) prostate biopsy in the detection of prostate cancer (PCa). A meta-analysis was performed by searching the databases Pubmed, Embase and Web of science for the relevant available studies until September 1st, 2016, and thirteen studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences of TR and TP groups in PCa detection rate. Then, trial sequential analysis was performed to reduce the risk of type I error and estimated whether the evidence of the results was reliable. Overall, this meta-analysis included a total of 4280 patients, who had been accrued between April 2000 and Aug 2014 and randomly divided into TR group and TP group. Prostate biopsies included sextant, extensive and saturation biopsy procedures. Patients who received TP prostate biopsy had no significant improvement in PCa detection rate, comparing TR group. Moreover, when comparing TR and TP studies, no significant difference was found in abnormal DRE findings, serum PSA level measurement, Gleason score, prostate volume. Besides, this meta-analysis showed no obvious differences between these two groups in terms of relevant complications. Therefore, this meta-analysis revealed that no significant differences were found in PCa detection rate between TP and TR approaches for prostate biopsy. However, with regard to pain relief and additional anesthesia, TR prostate needle biopsy was relatively preferable, compared to TP prostate biopsy.

Keywords: meta-analysis; prostate biopsy; prostate cancer; transperineal; transrectal.

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Conflict of interest statement

CONFLICTS OF INTEREST

We declare that we have no conflict of interest.

Figures

Figure 1
Figure 1. Flow diagram of literature search and selection process
Figure 2
Figure 2. Forest plots of PCa detection rate compared with TR and TP prostate biopsy
A. Forest plots of efficacy of TR versus TP prostate biopsy in the PCa detection rate; B. Forest plots of subgroup analysis by number of biopsy cores in the PCa detection rate compared with the two; C. Forest plots of subgroup analysis by ethnicity in the PCa detection rate compared with the two.
Figure 3
Figure 3. Forest plots of abnormal DRE findings compared with TR and TP prostate biopsy
A. Forest plots of efficacy of TR versus TP prostate biopsy in abnormal DRE findings; B. Forest plots of subgroup analysis by number of biopsy cores in abnormal DRE findings compared with the two; C. Forest plots of subgroup analysis by ethnicity in abnormal DRE findings compared with the two.
Figure 4
Figure 4. Forest plots of different PSA levels compared with TR and TP prostate biopsy
A. Forest plots of efficacy of TR versus TP prostate biopsy in PSA≤4ngml−1; B. Forest plots of efficacy of TR versus TP prostate biopsy in 4ngml−1<PSA≤10 ng ml−1; C. Forest plots of efficacy of TR versus TP prostate biopsy in 10ngml−1<PSA≤20ngml−1; D. Forest plots of efficacy of TR versus TP prostate biopsy in PSA>20ngml−1.
Figure 5
Figure 5. Forest plots of different PSA levels (PSA≤10ngml−1 and PSA>10ngml−1) compared with TR and TP prostate biopsy
A. Forest plots of efficacy of TR versus TP prostate biopsy in PSA≤10ngml−1; B. Forest plots of efficacy of TR versus TP prostate biopsy in PSA>10ngml−1; C. Forest plots of subgroup analysis by number of biopsy cores in PSA≤10ngml−1 compared with the two; D. Forest plots of subgroup analysis by number of biopsy cores in PSA>10ngml−1 compared with the two.
Figure 6
Figure 6. Forest plots of biopsy Gleason score compared with TR and TP prostate biopsy
A. Forest plots of efficacy of TR versus TP prostate biopsy in Gleason score ≤6; B. Forest plots of efficacy of TR versus TP prostate biopsy in Gleason score =7; C. Forest plots of efficacy of TR versus TP prostate biopsy in Gleason score ≥8; D. Forest plots of subgroup analysis by number of biopsy cores in Gleason score ≤6 compared with the two; E. Forest plots of subgroup analysis by number of biopsy cores in Gleason score =7 compared with the two; F. Forest plots of subgroup analysis by number of biopsy cores in Gleason score ≥8 compared with the two.
Figure 7
Figure 7. Forest plots of prostate volume compared with TR and TP prostate biopsy
A. Forest plots of efficacy of TR versus TP prostate biopsy in prostate volume <30ml; B. Forest plots of efficacy of TR versus TP prostate biopsy in 30 ml≤prostate volume ≤50 ml D; C. Forest plots of efficacy of TR versus TP prostate biopsy in prostate volume ≥50 ml.
Figure 8
Figure 8. Begg's funnel plot of publication bias test in the PCa detection rate compared with TR and TP prostate biopsy
Figure 9
Figure 9. Trial sequential analysis of efficacy of TR versus TP prostate biopsy
A. TSA of PCa detection rate compared with TR and TP prostate biopsy; B. TSA of abnormal DRE findings compared with TR and TP prostate biopsy. The required information size was calculated based on a two side α= 5%, β= 20% (power 80%), and a relative risk reduction of 20%.
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