A review of transrectal ultrasound guided prostate biopsies: Is there still a role for finger guided prostate biopsies?

Abstract

Objective: We compared our institution’s initial experience with transrectal ultrasound-guided (TRUS) prostate biopsies in a single arm prospective study to a historical cohort of finger guided (FG) biopsies. The primary outcome measure was prostate cancer detection. We documented our findings on TRUS including the findings of peripheral calcifications, hypoechoic lesions and capsular distortion and evaluated whether these had any significance in prostate cancer detection.

Patients and methods: All patients presenting to our institution for prostate biopsy were included. Indications included raised PSA and/or abnormal DRE or other suspicion of prostate cancer. Data on 12-core TRUS guided biopsies were prospectively collected and compared to a historical cohort of 6-core FG biopsies obtained from the pathology database of all prostate biopsies performed at Groote Schuur Hospital within the study period.

Results: One hundred and ninety-two patients were included in the TRUS group over a 25-month period (2008–2010) and 262 FG biopsies were reviewed between 2006 and 2008. Abnormal DRE findings were present in 56.2% of FG and 43.3% of TRUS biopsies. Histology was available in 97.8% of cases. The incidence of prostate cancer was 42%. Malignant or suspicious histology was found in 45.6% of the FG group compared to 48.6% in the TRUS group (p = 0.27). In patients with a normal DRE there was a trend that favoured TRUS for improved cancer detection, which is significant if the PSA was below 10 ng/mL.

Conclusion: Our study did not show superiority of TRUS over FG biopsies except when the patient had a low PSA (below 10 ng/mL) and a normal DRE. Systematic FG biopsies may be underutilised in the TRUS era, and may be of benefit in patients presenting with a PSA over 10 ng/mL or an abnormal DRE. This may be of value in a limited resource setting where access to TRUS is restricted.

Keywords: Prostate cancer; Prostate biopsy; Transrectal ultrasound; Finger-guided prostate biopsy