An Autopsy Study On The Sensitivity Of Transperineal And Transrectal Biopsy For The Diagnosis Of Prostate Cancer

Background The exact prevalence of prostate cancer is difficult to estimate because latent prostate cancer may not show any clinical syptoms.As a result accuracy differences between transperineal and transrectal prostate biopsies remain controversial.The accurate natural history of prostate cancer(PC)can be obtained from autopsy studies.Methods Our study collected 64 prostate glands from donated bodies without history of prostate cancer since 2014.We peformed transpereneal and transrectal 12-core needle biopsies on each autopsy prostates.The main glands were cut into 2mm sections and further sectioned to produce 5-?m whole mount sections that were stained with hematoxylin and eosin We analyzed the prevalence and pathological characteristics of latent prostate cancer and compared the differences between two biopsy methods.Results Of 64 autopsied males aged 47-99,the overall prevalence of latent PC is 39.1%.Patients in their 7th decades had the highest prevalence(53%).Of the 25 PC glands,17 were clinically significant.Tumor grade(Gleason score)was associated with total tumor volume(P<0.01).Of the 15 multifocal cancers,heterogenetic tumors had larger average volume than homogeneous cases(P=0.019).The prevalence of latent PC in peripheral zone is significant bigher than central zone(36%vs 13%,X2=5.842 P=0.016)while prevalence in apex and middle gland is higher than basal part(X2=6.249 P=0.04).The sensitivity of transpeneal biopsy(40%,95%CI=22-61%)shows no significant difference with the sensitivity of transrectal biopsy(44%,95%CI=25-65%)and consistency of two biopsy methods is fine(P<0.01 Kappa=0.601).The sensitivities of two biopsy methods for different pathological subgroups show no statistical difference(P>0.05).While the transperineal biopsy shows better consistency between biopsy patholbgical grade and final pathotogical diagnosis(100%vs 73%,P=0.045).Conclusions The overall prevalence of latent PC in our autopsy study is 39.1%with a relative high prevaence in 70-79 years okl male.Major sites of predilection are peripheral zone and apex.The sensitivity and accuracy of transperineal biopsy and transrectal biopsy are equal.