SYSTEMIC INFLAMMATORY RESPONSE AFTER TRANSRECTAL VS TRANSPERINEAL PROSTATE BIOPSY
##plugins.themes.bootstrap3.article.main##
##plugins.themes.bootstrap3.article.sidebar##
Abstract
Objective: This study compares the inflammatory responses of TR and TP biopsies, using the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers. Material & Methods: A retrospective cohort study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia, from January 2023 to August 2025, involving 46 patients who underwent TR or TP biopsies. Pre- and post-procedure blood samples were analyzed for NLR and PLR. Statistical analysis was performed using SPSS, employing paired t-tests and Mann-Whitney U tests. Results: NLR before the procedure was significantly higher in the TR group (p = 0.034). Post-procedure, there were no significant changes in NLR or PLR (p > 0.05). Infections and fever occurred more frequently in the TR group (12% and 24%, respectively), with no complications in the TP group. Prostate cancer detection rates were similar between both groups (p = 0.760). Discussion: Both biopsy methods induced systemic inflammation, as reflected by increased NLR and PLR post-procedure. However, TR biopsies were linked to a higher incidence of infections and febrile episodes. This aligns with prior studies indicating a greater complication rate with TR biopsies. NLR may serve as a potential biomarker for assessing tumor aggressiveness, especially in TR biopsy patients, where NLR changes were more pronounced among those diagnosed with prostate cancer. Conclusion: TP biopsies present lower infection risk and similar diagnostic accuracy compared to TR biopsies. NLR and PLR may be useful biomarkers for tracking inflammatory responses post-biopsy. Larger studies are needed to confirm these findings. Keywords: Prostate cancer, prostate biopsy, transrectal biopsy, transperineal biopsy, NLR, PLR, inflammatory response, infection.
##plugins.themes.bootstrap3.article.details##
Prostate cancer, prostate biopsy, transrectal biopsy, transperineal biopsy, NLR, PLR, inflammatory response, infection.
Mattiuzzi C, Lippi G. Current Cancer Epidemiology: JEGH. 2019;9(4):217.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer J Clinicians. 2021 May;71(3):209-49.
Global Cancer Observatory. Indonesia Cancer Factsheet [Internet]. 2022 [cited 2025 Apr 10]. Available from: https://gco.iarc.who.int
Sekhoacha M, Riet K, Motloung P, Gumenku L, Adegoke A, Mashele S. Prostate Cancer Review: Genetics, Diagnosis, Treatment Options, and Alternative Approaches. Molecules. 2022 Sep 5;27(17):5730.
Thomson A, Li M, Grummet J, Sengupta S. Transperineal prostate biopsy: a review of technique. Transl Androl Urol. 2020 Dec;9(6):3009-17.
Pradere B, Veeratterapillay R, Dimitropoulos K, Yuan Y, Omar MI, MacLennan S, et al. Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis. Journal of Urology. 2021 Mar;205(3):653-63.
Berry B, Parry MG, Sujenthiran A, Nossiter J, Cowling TE, Aggarwal A, et al. Comparison of complications after transrectal and transperineal prostate biopsy: a national population-?
Cowan T, Baker E, McCray G, Reeves F, Houlihan K, Johns? Putra L. Detection of clinically significant cancer in the anterior prostate by transperineal biopsy. BJU International. 2020 Sep;126(S1):33-7.
Stefanova V, Buckley R, Flax S, Spevack L, Hajek D, Tunis A, et al. Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability. Journal of Urology. 2019 Jun;201(6):1121-6.
Koparal MY, Sözen TS, Kar??yakal? N, Aslan G, Akdo?an B, ?ahin B, et al. Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association. The Prostate. 2022 Mar;82(4):425-32.
Jiang CY, Shen PF, Wang C, Gui HJ, Ruan Y, Zeng H, et al. Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study. Asian J Androl. 2019;21(6):612.
Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and
meta-analysis. World J Surg Onc. 2019 Dec;17(1):31.
Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Modern Rheumatology. 2016 May 3;26(3):372-6.
Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure. Arq Bras Cardiol. 2015 Dec;105(6):606-13.
Anastasakis M, Trevlias I, Farmakis K, Valioulis I. The Importance of the Neutrophil-Lymphocyte Ratio (NLR) and the Platelet-Lymphocyte Ratio (PLR) as Biomarkers for Differentiating Complicated and Uncomplicated Appendicitis. Diagnostics. 2024 Dec 11;14(24):2777.
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357(9255):539-545.
Gokce MI, Tangal S, Hamidi N, et al. Predictive value of neutrophil-to-lymphocyte ratio in prostate cancer detection. Medicine (Baltimore). 2016;95(36):e4479.
Tang Y, Wang J, Chen M, et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to- lymphocyte ratio in prostate cancer: a meta-analysis. Transl Androl Urol. 2023;12(4):537-547.
Lu M, Luo Y, Wang Y, Yu J, Zheng H, Yang Z. Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients. BMC Urol. 2023 Jan 28;23(1):11.
Hu JC, Assel M, Allaf ME, Vickers AJ, Ehdaie B, Cohen AJ, et al. Transperineal vs Transrectal Prostate Biopsy-The PREVENT Randomized Clinical Trial. JAMA Oncol. 2024 Nov 1;10(11):1590.
Acosta H, Sadahira T, Sekito T, Maruyama Y, Iwata T, Araki M, et al. Post-?
Feliciano J, Teper E, Ferrandino M, Macchia RJ, Blank W, Grunberger I, et al. The Incidence of Fluoroquinolone Resistant Infections After Prostate Biopsy-Are Fluoroquinolones Still Effective Prophylaxis? Journal of Urology. 2008 Mar;179(3):952-5.
Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis. Journal of Urology. 2020 Feb;203(2):351-6.
Yamamoto S, Shigemura K, Kiyota H, Wada K, Hayami H, Yasuda M, et al. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J of Urology. 2016 Oct;23(10):814-24.
Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, et al. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. European Urology. 2024 Jul;86(1):27-41.
Elshal AM, Atwa AM, El-Nahas AR, El-Ghar MA, Gaber A, Elsawy E, et al. Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial. World J Urol. 2018 Nov;36(11):1845-52.
Bennett HY, Roberts MJ, Doi SAR, Gardiner RA. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect. 2016;144(8):1784-1791
Gokce MI, Hamidi N, Suer E, Tangal S, Huseynov A, Ibi? A. Evaluation of neutrophil-to-lymphocyte ratio prior to prostate biopsy to predict biopsy histology: Results of 1836 patients. Can Urol Assoc J. 2015 Nov- Dec;9(11-12):E761-5.
Mian BM, Feustel PJ, Aziz A, et al. Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial. J Urol. 2023; 210(2): 460-465