Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study

Abstract

This study compared the diagnostic efficacy of transrectal ultrasound (TRUS)-guided prostate biopsy (TRBx) and transperineal prostate biopsy (TPBx) in patients with suspected prostate cancer (PCa). We enrolled 2962 men who underwent transrectal (n = 1216) or transperineal (n = 1746) systematic 12-core prostate biopsy. Clinical data including age, prostate-specific antigen (PSA) level, and prostate volume (PV) were recorded. To minimize confounding, we performed propensity score-matching analysis. We measured and compared PCa detection rates between TRBx and TPBx, which were stratified by clinical characteristics and Gleason scores. The effects of clinical characteristics on PCa detection rate were assessed by logistic regression. For all patients, TPBx detected a higher proportion of clinically significant PCa (P < 0.001). Logistic regression analyses illustrated that PV had a smaller impact on PCa detection rate of TPBx compared with TRBx. Propensity score-matching analysis showed that the detection rates in TRBx were higher than those in TPBx for patients aged >- 80 years (80.4% vs 56.5%, P = 0.004) and with PSA level 20.1-100.0 ng ml^-1 (80.8% vs 69.1%, P = 0.040). In conclusion, TPBx was associated with a higher detection rate of clinically significant PCa than TRBx was; however, because of the high detection rate at certain ages and PSA levels, biopsy approaches should be optimized according to patents' clinical characteristics.

Keywords: Gleason score; biopsy; demography; propensity score; prostatic neoplasms.

Figure 1

Schemes of cores in TRBx and TPBx. (a) Scheme of 12 cores in transrectal approach on prostatic coronal and sagittal plane. (b) Scheme of 12 cores in transperineal approach on prostatic cross-sectional and sagittal plane. TRBx: transrectal biopsy; TPBx: transperineal biopsy.

Figure 2

Balanced diagnostics for comparing the distribution of baseline covariates (age, PSA level and PV) between TRBx group and TPBx group. (a) Jitter plot of distribution of individual patients' propensity scores. (b) Line plot of standardized differences. (c) Histogram of distribution of patients' propensity scores in unmatched and matched TPBx groups. (d) Histogram of distribution of patients' propensity scores in unmatched and matched TRBx groups. (e) Histogram of standardized differences between the two groups before and after matching. (f) Differences of baseline covariates before and after matching. TRBx: transrectal biopsy; TPBx: transperineal biopsy; PSA: prostate-specific antigen; PV: prostate volume.