1 3 Int Urol Nephrol DOI 10.1007/s11255-015-0967-3 UROLOGY - ORIGINAL PAPER Advantages of single-puncture transperineal saturation biopsy of prostate: analysis of outcomes in 125 patients using our scheme Eugenio Martorana 1 · Salvatore Micali 1 · Ahmed Ghaith 2 · Luca Reggiani Bonetti 3 · Maria Chiara Sighinolfi 1 · Riccardo Galli 1 · Maurizio Paterlini 1 · Giampaolo Bianchi 1 Received: 21 January 2015 / Accepted: 28 March 2015 © Springer Science+Business Media Dordrecht 2015 Conclusion The traditional saturation biopsy may be use- ful when targeted biopsy cannot be used. Our technique is accurate for cancer detection. It can offer some advantages in comparison with other approaches. Keywords Detection rate · Prostate cancer · Saturation biopsy · Transperineal single puncture Introduction Prostate biopsy is the gold standard for the diagnosis of prostate cancer (PCa), and its role has changed over time from being only for cancer detection to becoming an informative method. Prostate biopsy can be used now for accurate morphologic characterization of PCa, including volume, pathological stage, and Gleason score [1]. Prostate biopsies are performed for elevated serum prostate-specific antigen (PSA) and digital rectal examination (DRE) abnor- malities [2]. The first needle prostate biopsy was performed through the perineum by Barringer in 1922 [3]. The transrectal procedure is considered the standard of care for performing prostate biopsies guided by ultrasound. Recently, there has been growing interest in prostate biopsy by the transperineal approach, because it has the advantages of fewer complications and a greater PCa detection rate [4]. After the initial introduction of the sextant prostate biopsy technique proposed by Hodge in 1989, Stamey suggested directing the biopsies more laterally in the peripheral zone (PZ) [1, 5, 6]. Eskew et al. [7] introduced the five-region technique of pros- tate biopsy in which the conventional sextant biopsies were taken with two additional cores from the far lateral and mid-regions of the gland. Nowadays, the extended Abstract Purpose Stereotactic biopsy has improved prostate can- cer detection. Although the new approach is superior, standard procedure is still useful in a cohort of patients in whom MRI is not available. The standard saturation biopsy technique is still debatable. We describe our technique and analyze its outcomes. Materials and methods One hundred twenty-five patients underwent saturation biopsy through a single transperineal access. Mean age was 64.73 year, mean PSA was 9.49 ng/ ml, mean PSA density was 0.184, and mean prostate vol- ume was 57.95 g. All patients underwent at least one pre- vious prostatic biopsy: 24.8 % of cases had diagnosis of atypical small acinar proliferation, 39.2 % of cases had multifocal high-grade prostatic intraepithelial neoplasia, and 36 % of cases had inflammation or benign prostatic hyperplasia. Results The detection rate was 38.4 %. Prostate can- cer occurred in 61.3 % of patients with previous ASAP (p < 0.007). Cancer detection rate decreased with increas- ing number of previous biopsy and with increasing pros- tate volume (p < 0.001) and increased with increasing PSA density (p = 0.03). No major complications were reported. * Eugenio Martorana eugeniomartorana@libero.it 1 Policlinico di Modena, Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy 2 Urology Department, Tanta University, Tanta, Egypt 3 Laboratory and Pathologic Anatomy, Department of Forensic Medicine, University of Modena e Reggio Emilia, Modena, Italy