Superior prostate cancer detection with LATP versus TRUS

Abstract

For men suspected of having prostate cancer, transperineal prostate biopsy under local anesthesia (LATP) offers superior prostate cancer detection over the conventional approach using transrectal ultrasound (TRUS), according to the results of the Transrectal Versus Local Anesthesia Transperineal Prostate Biopsy Evaluation (TRANSLATE) trial published in The Lancet Oncology.¹

In biopsy-naive men, LATP led to significantly greater detection of Gleason grade group (GGG) 2 or higher prostate cancer compared to TRUS (60% vs. 54%, p = .03).¹

According to the authors, who were led by Richard Bryant, PhD, an associate professor of urology in the Nuffield Department of Surgical Sciences at the University of Oxford, on behalf of the TRANSLATE Trial Study Group, this is the largest randomized controlled trial to compare these two approaches and the first to show the superiority of LATP over TRUS in detecting GGG 1 or higher prostate cancer. They speculate that the improved targeting of radiologic lesions with LATP may be one reason for its higher detection of prostate cancer over TRUS.¹

Conducted in the United Kingdom, the multicenter, open-label, randomized superiority study included 1126 adult men (aged 18 years or older) who were randomized to LATP (n = 562) or TRUS biopsy (n = 564). All participants were suspected to have prostate cancer based on elevated age-specific prostate-specific antigen levels, abnormal digital rectal examinations, or prebiopsy magnetic resonance imaging on a 1.5-T or higher scanner.

The study also showed a lower risk of infection with LATP, with <1% of patients requiring hospital admission within the 35 days after biopsy versus 2% of those undergoing TRUS. Although not statistically significant, the lower risk of infection indicates that most men who undergo LATP will not require antibiotics. Antibiotics were not used in most of the men undergoing LATP in the study, whereas all men undergoing TRUS received them.

Four months after the procedures, no difference in biopsy-related complications, including urinary retention requiring catheterization, urinary symptoms, and sexual function, was seen between LATP and TRUS.

However, the downsides of LATP included higher immediate postprocedural pain and embarrassment compared to TRUS (38% vs. 27%) and a longer time to perform (median in the room, 28 vs. 22 min; median to perform the biopsy, 12 vs. 8 min).

Commenting on the study, Abhinav Sidana, MBBS, an associate professor of surgery and director of prostate cancer focal therapy at the University of Chicago Medicine in Illinois, says that the study indicates that the majority of patients who need to undergo prostate biopsy should be offered LATP.

“Transperineal biopsy should be the preferred diagnostic approach for most men suspected of having prostate cancer,” he says, emphasizing the study results showing that along with achieving superior cancer detection rates, LATP minimizes infectious complications and can help patients to avoid the use of antibiotics.

However, he says that TRUS may remain appropriate for some patients, such as those unfit for the lithotomy position required for LATP, those without access to LATP, and those for whom cost and logistics limit the transperineal biopsy setup.

He says that TRUS may be better for some obese men with larger prostates and lesions located at the base of the prostate, as a transperineal biopsy under local anesthesia may be more difficult in this situation.