Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis

// Jianxin Xue 1, 2, *, Zhiqiang Qin 2, *, Hongzhou Cai 3, *, Chuanjie Zhang 4, Xiao Li 3, Weizhang Xu 5, Jingyuan Wang 6, Zicheng Xu 3, Bin Yu 3, Ting Xu 3, Qin Zou 3 1 Department of Urology, The Second Affiliated Hospital of Southeast University, Nanjing, 210003, China 2 Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China 3 Department of Urologic Surgery, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, 210009, China 4 First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China 5 Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, 210009, China 6 Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China * These authors have contributed equally to this work Correspondence to: Bin Yu, email: yubinᵤrology@sina. com Ting Xu, email: xutingᵤrology@sina. com Keywords: transperineal, transrectal, prostate biopsy, prostate cancer, meta-analysis Received: October 25, 2016 Accepted: December 01, 2016 Published: February 03, 2017 ABSTRACT To systematically assess the efficacy and complications of transrectal (TR) versus transperineal (TP) prostate biopsy in the detection of prostate cancer (PCa). A meta-analysis was performed by searching the databases Pubmed, Embase and Web of science for the relevant available studies until September 1st, 2016, and thirteen studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences of TR and TP groups in PCa detection rate. Then, trial sequential analysis was performed to reduce the risk of type I error and estimated whether the evidence of the results was reliable. Overall, this meta-analysis included a total of 4280 patients, who had been accrued between April 2000 and Aug 2014 and randomly divided into TR group and TP group. Prostate biopsies included sextant, extensive and saturation biopsy procedures. Patients who received TP prostate biopsy had no significant improvement in PCa detection rate, comparing TR group. Moreover, when comparing TR and TP studies, no significant difference was found in abnormal DRE findings, serum PSA level measurement, Gleason score, prostate volume. Besides, this meta-analysis showed no obvious differences between these two groups in terms of relevant complications. Therefore, this meta-analysis revealed that no significant differences were found in PCa detection rate between TP and TR approaches for prostate biopsy. However, with regard to pain relief and additional anesthesia, TR prostate needle biopsy was relatively preferable, compared to TP prostate biopsy.