The Utility of Transperineal Template Saturation Biopsy in the Detection of Clinically Significant Prostate Cancer

Aim: We investigated the role of transperineal template saturation biopsy (TTSB) in detecting clinically significant prostate cancer (csPCa). We compared the TTSB findings with multiparametric magnetic resonance imaging (mpMRI) findings in suspected prostate cancer patients. Methods: This retrospective study included 124 patients who underwent TTSB following mpMRI at our institute. We examined factors contributing to csPCa detection in these patients. We examined the association between the Prostate Imaging-Reporting and Data System (PI-RADS) Version 2.1 category and csPCa detection. Results: The median age at TTSB was 68 (interquartile range: 62-73) years, and the median prostate-specific antigen level was 9.9 (6.1-15.5) ng/mL. Herein, 61.3% (76/124) of the patients who underwent TTSB had cancer and 35.5% (44/124) had csPCa. Abnormal digital rectal examination findings (p=0.006) and PI-RADS category ≥ 4 (p < 0.001) were independent factors for csPCa detection. Among patients categorized as PI-RADS ≥ 4, 64.8% (35/54) had csPCa; csPCa frequency increased with increasing PI-RADS categories (p < 0.001). Cancer was detected in 38.3% (23/60) of the patients categorized as PI-RADS ≤ 2; among them, 10% (6) had csPCa. Only 3.2% (4/124) of the patients had TTSB-related adverse events ≥ grade 2, 0.8% (1/124) suffered from hematuria, and 2.4% (3/124) had acute urinary retention. All patients were treated conservatively. Conclusions: Patients with a higher PI-RADS category tended to have csPCa. However, the PI-RADS category alone may not be sufficient for csPCa detection. TTSB detected csPCa in 10% of the patients with negative mpMRI findings. TTSB is a safe and crucial technique for accurately diagnosing prostate cancer.