Systematic transperineal ultrasound guided template biopsy of the prostatein patients at high risk

Purpose: A negative biopsy result does not necessarily equate with cancer i n specific high risk groups. We describe an alternative systematic biopsy t echnique for evaluating this subgroup of patients. Materials and Methods: From March 1997 to May 1999 a total of 88 men underw ent systematic ultrasound guided biopsy using: the transperineal template t echnique. All patients had undergone at least 1 and 75 (85%) had undergone 2 or more previous sets of biopsies. In addition, study inclusion required high risk parameters, including prostate specific antigen (PSA) velocity gr eater than 0.75 ng./ml., PSA greater than 10 ng./ml. or previous prostatic intraepithelial neoplasia an biopsy, and/or atypical small cell acinar prol iferation. Results: Cancer was identified in 38 of the 88 men (43%) in this high risk subgroup undergoing repeat biopsy. A mean of 15.1 previous biopsy cores had been obtained. The most common biopsy grade was 6 (range 1 to 9). Adenocar cinoma was identified in the transition zone area in 29 of 38 cases (76%), including 15 (39%) in which disease was detected in the transition zone onl y. Persistent PSA acceleration greater than 0.75 ng./ml. was the major indi cator for transperineal template biopsy in 83 of the 88 patients (94%). The only significant independent variable predictive of positive biopsy was pr ostate volume. Mean prostate volume in the positive and negative biopsy gro ups was 48 and 73 gm., respectively (p <0,001). Complications were rare and self-limiting, consisting primarily of hematuria and urinary retention req uiring overnight catheterization in 2 patients. Conclusions: Systematic transperineal template biopsy of the prostate is a safe and precise repeat biopsy technique in patients who remain at high ris k for adenocarcinoma.