Best approach for XXXX detection: a prospective study on transperineal versus transrectal six-core prostate biopsy.

@entity5 @entity1 @entity263 @entity1486
OBJECTIVES: To compare the efficacy of transperineal versus transrectal six-core prostate biopsy. Transrectal sextant biopsy is the most common method for @entity263 detection. However, the @entity5 detection rate with this technique is increasingly considered inadequate. Different prostate biopsy procedures, mainly based on addition of additional transrectal cores to traditional sextant biopsy, have been proposed to increase the @entity5 diagnosis rate. The efficacy of the transperineal approach has not yet been fully established. METHODS: In a prospective study, 107 @entity1 with elevated @entity1486 levels (greater than 4.0 ng/mL) underwent prostate biopsy with six transperineal cores, using a "fan" scheme, plus six transrectal cores, according to the sextant technique. The median @entity1486 level was 8.2 ng/mL (range 4.1 to 240). RESULTS: The overall @entity5 detection rate was 40% (43 of 107); @entity263 was found in 38% (41 of 107) of @entity1 with the transperineal approach and in 32% (34 of 107) of @entity1 with the transrectal approach. Of 43 diagnosed @entity5 , 41 (95%) were found with the transperineal approach and 34 (79%) with the transrectal approach (P = 0.012). No @entity1 had low-grade @entity5 (Gleason score 2 to 4), 25 @entity1 had intermediate-grade @entity5 (Gleason score 5 to 6), and 18 @entity1 had high-grade @entity5 (Gleason score 7 to 10). CONCLUSIONS: This is the first report comparing in vivo two different approaches to prostate biopsy. Transperineal biopsy seems superior to transrectal biopsy to detect @entity263 . Both the transperineal and the transrectal approach should be familiar to the urologist who needs to obtain an adequate @entity5 detection rate. Transrectal sextant biopsy cannot be considered the standard technique for @entity263 detection.
