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Hennes D, Al-Khanaty A, Chen DC, Dineen E, Babst C, Lawrentschuk N, Perera ML, Murphy DG. Re: Local Anaesthetic Transperineal Biopsy Versus Transrectal Prostate Biopsy in Prostate Cancer Detection (TRANSLATE): A Multicentre, Randomised, Controlled Trial. Eur Urol 2025:S0302-2838(25)00288-X. [PMID: 40382299 DOI: 10.1016/j.eururo.2025.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2025] [Revised: 04/26/2025] [Accepted: 05/08/2025] [Indexed: 05/20/2025]
Affiliation(s)
- David Hennes
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Hudson Institute of Medical Research, Clayton, Australia
| | - Abdullah Al-Khanaty
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Urology, Austin Hospital, Heidelberg, Australia
| | - David C Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Urology, Austin Hospital, Heidelberg, Australia
| | - Eoin Dineen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Christa Babst
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Marlon L Perera
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Urology, Austin Hospital, Heidelberg, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Urology, Austin Hospital, Heidelberg, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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Bayraktar Z, Sahinler EB, Yildirim S, Saglam NO, Birinci SC, Sinanoglu O, Sahin C. Comparison of cognitive magnetic resonance-ultrasonography fusion prostate biopsy outcomes in left lateral decubitus vs lithotomy positions: a prospective randomized study cognitive magnetic resonance-ultrasonography fusion prostate biopsy. Int Urol Nephrol 2025:10.1007/s11255-025-04544-9. [PMID: 40317430 DOI: 10.1007/s11255-025-04544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2025] [Accepted: 04/22/2025] [Indexed: 05/07/2025]
Abstract
INTRODUCTION The study compares the results of cognitive MRI-ultrasonography fusion prostate biopsy in two positions: left lateral decubitus (LLD) and lithotomy. METHODS From June 2023 to December 2024, 200 patients were randomly assigned to two groups (100 in LLD and 100 in lithotomy). Age, BMI, prostate volume, comorbidities, PSA levels, DRE (+) status, and PI-RADS ≥ 3 lesions were recorded. Pain was measured using the visual analog scale (VAS), and complications were monitored. Histopathological results were collected and analyzed. RESULTS No significant differences were found between the groups in terms of age, BMI, PSA, DRE status, prostate volume, comorbidities, or PI-RADS ≥ 3 lesions. Cancer detection rates were 38% in the LLD group and 32% in the lithotomy group (p = 0.550). The average VAS score was lower in the LLD group (2.41 ± 2.30) compared to the lithotomy group (3.22 ± 2.88) (p = 0.030). The mean Gleason score was similar between groups (LLD: 7.05 ± 1.11, Lithotomy: 7.29 ± 1.04; p = 0.247). No major complications occurred, but hematuria was more frequent in the lithotomy group (p = 0.006). CONCLUSIONS There were no significant differences in cancer detection rates or grades between the two groups. The lithotomy position had slightly higher pain scores but no major complications. Hematuria occurred more often in the lithotomy position. Cognitive MRI-US fusion biopsy is safe in both positions.
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Affiliation(s)
- Zeki Bayraktar
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Emre Burak Sahinler
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Salih Yildirim
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
| | - Nuri Oguzhan Saglam
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Sedat Can Birinci
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Orhun Sinanoglu
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Cahit Sahin
- Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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Mian BM, Tikkinen KAO, Kibel AS. Transrectal versus transperineal prostate biopsy: weighing the trade-offs. Lancet Oncol 2025; 26:533-535. [PMID: 40139211 DOI: 10.1016/s1470-2045(25)00160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2025] [Accepted: 03/17/2025] [Indexed: 03/29/2025]
Affiliation(s)
- Badar M Mian
- Department of Urology, Albany Med Health System, Albany, New York, NY 12208, USA.
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Adam S Kibel
- Department of Urology, Mass General Brigham, Boston, MA, USA
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Bryant RJ, Marian IR, Williams R, Lopez JF, Mercader C, Raslan M, Berridge C, Whitburn J, Campbell T, Tuck S, Barber VS, Scaife J, Hewitt A, Taylor A, Ooms A, Landeiro F, Little M, Wolstenholme J, Ghosh S, Reynard JM, Hamdy FC, Liew MPC, Leslie TA, Catto JWF, Rosario DJ, Omer A, Good DW, Gray RH, Kommu S, Chung D, Wells H, Narahari K, Macpherson RE, Verrill C, Eddy B, Yamamoto H, Lamb AD. Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial. Lancet Oncol 2025; 26:583-595. [PMID: 40139210 DOI: 10.1016/s1470-2045(25)00100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 02/19/2025] [Accepted: 02/20/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Prostate cancer diagnosis requires biopsy, traditionally performed under local anaesthetic with ultrasound guidance via a transrectal approach (TRUS). Local anaesthetic ultrasound-guided transperineal biopsy (LATP) is gaining popularity in this setting; however, there is uncertainty regarding prostate sampling, infection rates, tolerability, side-effects, and cost-effectiveness. TRANSLATE was a randomised clinical trial that aimed to compare detection of Gleason Grade Group (GGG) 2 or higher prostate cancer, side-effects, tolerability, and patient-reported outcomes, after LATP versus TRUS biopsy. METHODS In this randomised clinical trial which was done at ten hospitals in the UK, patients aged 18 years or older were eligible if investigated for suspected prostate cancer based on elevated age-specific prostate-specific antigen or abnormal digital rectal examination, and if biopsy-naive having received pre-biopsy MRI on a 1·5 or higher Tesla scanner. Individuals were excluded if they had any previous prostate biopsy, extensive local disease easily detectable by any biopsy (prostate-specific antigen >50 ng/mL or entire gland replaced by tumour on MRI), symptoms of concurrent or recent urinary tract infection, history of immunocompromise, need for enhanced antibiotic prophylaxis, absent rectum, or inability to position in lithotomy. Participants were randomly assigned in a 1:1 ratio to receive LATP or TRUS biopsy, using web-based software with a randomisation sequence using a minimisation algorithm to ensure balanced allocation across biopsy groups for minimisation factors (recruitment site, and location of the MRI lesion). The primary outcome was detection of GGG 2 or higher prostate cancer, analysed in the modified intention-to-treat population (all randomly assigned to treatment who had a biopsy result available). Key secondary endpoints assessing post-biopsy adverse events were infection, bleeding, urinary and sexual function, tolerability, and patient-reported outcomes. This trial is registered with ClinicalTrials.gov (NCT05179694) and at ISRCTN (ISRCTN98159689), and is complete. FINDINGS Between Dec 3, 2021, and Sept 26, 2023, 2078 (76%) of 2727 assessed individuals were eligible, and 1126 (41%) of 2727 agreed to participate. 1044 (93%) of the 1126 participants were White British. Participants were allocated to TRUS (n=564) or LATP (n=562) biopsy, and were followed up at time of biopsy, and at 7 days, 35 days, and 4 months post-biopsy. We found GGG 2 or higher prostate cancer in 329 (60%) of 547 participants with biopsy results randomly assigned to LATP compared with 294 (54%) of 540 participants with biopsy results randomly assigned to TRUS biopsy (odds ratio [OR] 1·32 [95% CI 1·03-1·70]; p=0·031). Infection requiring admission to hospital within 35 days post-biopsy occurred in 2 (<1%) of 562 participants in the LATP group compared with 9 (2%) of 564 in the TRUS group. No statistically significant difference was observed in the reporting of overall biopsy-related complications (LATP 454 [81%] of 562 vs TRUS 436 [77%] of 564, OR 1·23 [95% CI 0·93 to 1·65]), urinary retention requiring catheterisation (LATP 35 [6%] of 562 vs TRUS 27 [5%] of 564), urinary symptoms (median International Prostate Symptom Score: LATP 8 [IQR 4-14] vs TRUS 8 [4-13], OR 0·36 [95% CI -0·38 to 1·10]), nor sexual function (median International Index of Erectile Function score: LATP 5 [2-25] vs TRUS 8 [3-24], OR -0·60 [-1·79 to 0·58]) at 4 months after biopsy. Trial participants more commonly reported LATP biopsy to be immediately painful and embarrassing compared with TRUS (LATP 216 [38%] of 562 vs TRUS 153 [27%] of 564; OR 1·84 [95% CI 1·40 to 2·43]). Serious adverse events occurred in 14 (2%) of 562 participants in the LATP group and 25 (4%) of 564 in the TRUS group. INTERPRETATION Among biopsy-naive individuals being investigated for possible prostate cancer, biopsy with LATP led to greater detection of GGG 2 or higher disease compared with TRUS. These findings will help to inform patients, clinicians, clinical guidelines, and policy makers regarding the important trade-offs between LATP and TRUS prostate biopsy. FUNDING National Institute for Health and Care Research (NIHR) Health Technology Assessment.
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Affiliation(s)
- Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Surgical Intervention Trials Unit, University of Oxford, Oxford, UK.
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roxanne Williams
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - J Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Claudia Mercader
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Mutie Raslan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Christopher Berridge
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Jessica Whitburn
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Teresa Campbell
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Steve Tuck
- Oxfordshire Prostate Cancer Support Group, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jessica Scaife
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Amy Taylor
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Matthew Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sukanya Ghosh
- Department of Radiology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - John M Reynard
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Freddie C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Matthew P C Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - Tom A Leslie
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes Hospital, Milton Keynes, UK
| | - James W F Catto
- Division of Clinical Medicine, University of Sheffield and Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Derek J Rosario
- Division of Clinical Medicine, University of Sheffield and Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Daniel W Good
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Robert Hr Gray
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Daniel Chung
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Hannah Wells
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Krishna Narahari
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Ruth E Macpherson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Ben Eddy
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Hide Yamamoto
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Barts Cancer Institute, Queen Mary University of London, London, UK
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Uleri A, Barret E, Fiard G, Lenfant L, Malavaud B, Renard-Penna R, Rozet F, Beauval JB, Salin A, Rouprêt M, Ploussard G. Risk of Upgrading at Final Pathology after Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Prostate Biopsies: A Post Hoc Analysis of the PERFECT Trial. Eur Urol Oncol 2025:S2588-9311(25)00096-3. [PMID: 40263078 DOI: 10.1016/j.euo.2025.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2025] [Accepted: 03/26/2025] [Indexed: 04/24/2025]
Affiliation(s)
- Alessandro Uleri
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France.
| | - Eric Barret
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Gaëlle Fiard
- Urology Department, Grenoble Alpes University Hospital, University Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Louis Lenfant
- Urology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Bernard Malavaud
- Urology Department, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Raphaële Renard-Penna
- Urology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - François Rozet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | | | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Morgan Rouprêt
- Urology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
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Belue MJ, Mukhtar V, Ram R, Gokden N, Jose J, Massey JL, Biben E, Buddha S, Langford T, Shah S, Harmon SA, Turkbey B, Aydin AM. External Validation of an Artificial Intelligence Algorithm Using Biparametric MRI and Its Simulated Integration with Conventional PI-RADS for Prostate Cancer Detection. Acad Radiol 2025:S1076-6332(25)00280-6. [PMID: 40221284 DOI: 10.1016/j.acra.2025.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/18/2025] [Accepted: 03/21/2025] [Indexed: 04/14/2025]
Abstract
PURPOSE Prostate imaging reporting and data systems (PI-RADS) experiences considerable variability in inter-reader performance. Artificial Intelligence (AI) algorithms were suggested to provide comparable performance to PI-RADS for assessing prostate cancer (PCa) risk, albeit tested in highly selected cohorts. This study aimed to assess an AI algorithm for PCa detection in a clinical practice setting and simulate integration of the AI model with PI-RADS for assessment of indeterminate PI-RADS 3 lesions. PATIENTS AND METHODS This retrospective cohort study externally validated a biparametric MRI-based AI model for PCa detection in a consecutive cohort of patients who underwent prostate MRI and subsequently targeted and systematic prostate biopsy at a urology clinic between January 2022 and March 2024. Radiologist interpretations followed PI-RADS v2.1, and biopsies were conducted per PI-RADS scores. The previously developed AI model provided lesion segmentations and cancer probability maps which were compared to biopsy results. Additionally, we conducted a simulation to adjust biopsy thresholds for index PI-RADS category 3 studies, where AI predictions within these studies upgraded them to PI-RADS category 4. RESULTS Among 144 patients with a median age of 70 years and PSA density of 0.17ng/mL/cc, AI's sensitivity for detection of PCa (86.6%) and clinically significant PCa (csPCa, 88.4%) was comparable to radiologists (85.7%, p=0.84, and 89.5%, p=0.80, respectively). The simulation combining radiologist and AI evaluations improved clinically significant PCa sensitivity by 5.8% (p=0.025). The combination of AI, PI-RADS and PSA density provided the best diagnostic performance for csPCa (area under the curve [AUC]=0.76). CONCLUSION The AI algorithm demonstrated comparable PCa detection rates to PI-RADS. The combination of AI with radiologist interpretation improved sensitivity and could be instrumental in assessment of low-risk and indeterminate PI-RADS lesions. The role of AI in PCa screening remains to be further elucidated.
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Affiliation(s)
- Mason J Belue
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.J.B., V.M., J.L.M., E.B., T.L., A.M.A.)
| | - Vaneeza Mukhtar
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.J.B., V.M., J.L.M., E.B., T.L., A.M.A.)
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (R.R., J.J., S.B., S.S.)
| | - Neriman Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (N.G.)
| | - Joe Jose
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (R.R., J.J., S.B., S.S.)
| | - Jackson L Massey
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.J.B., V.M., J.L.M., E.B., T.L., A.M.A.)
| | - Emily Biben
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.J.B., V.M., J.L.M., E.B., T.L., A.M.A.)
| | - Suryakala Buddha
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (R.R., J.J., S.B., S.S.)
| | - Timothy Langford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.J.B., V.M., J.L.M., E.B., T.L., A.M.A.)
| | - Sumit Shah
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (R.R., J.J., S.B., S.S.)
| | - Stephanie A Harmon
- Artificial Intelligence Resource, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (S.A.H.,)
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (B.T.)
| | - Ahmet Murat Aydin
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.J.B., V.M., J.L.M., E.B., T.L., A.M.A.).
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7
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Suartz C. Critical Appraisal of the TRANSLATE Trial. Clin Genitourin Cancer 2025; 23:102355. [PMID: 40378560 DOI: 10.1016/j.clgc.2025.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2025] [Accepted: 04/07/2025] [Indexed: 05/19/2025]
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8
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Jang JW, Abrams A, Jawahar A, Savas H, Yang XJ, Mehta V, Schnauss M, Schaeffer EM, Alam R, Ross AE. Detection of MRI-Invisible Disease Using PSMA PET/CT in a Patient Considering Focal Therapy. Case Rep Urol 2025; 2025:2981515. [PMID: 40177325 PMCID: PMC11964713 DOI: 10.1155/criu/2981515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 03/15/2025] [Indexed: 04/05/2025] Open
Abstract
Patient selection for focal therapy (FT) of prostate cancer requires the assessment of MRI and biopsy results. However, there is currently little guidance for the utility of PSMA PET/CT in FT planning. We describe the case of a man originally considered an ideal candidate for FT based on biopsy and MRI who was found to have a contralateral lesion-harboring cancer detected only on PSMA PET/CT. Trial Registration: ClinicalTrials.gov identifier: NCT05852041.
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Affiliation(s)
- Jae Woong Jang
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aaron Abrams
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anugayathri Jawahar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ximing J. Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vikas Mehta
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marina Schnauss
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward M. Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ridwan Alam
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashley E. Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Najjar S, Mirvald C, Danilov A, Labanaris A, Vlaicu AG, Giurca L, Sinescu I, Surcel C. Comparative Analysis of Diagnostic Accuracy and Complication Rate of Transperineal Versus Transrectal Prostate Biopsy in Prostate Cancer Diagnosis. Cancers (Basel) 2025; 17:1006. [PMID: 40149340 PMCID: PMC11940353 DOI: 10.3390/cancers17061006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 02/23/2025] [Accepted: 03/05/2025] [Indexed: 03/29/2025] Open
Abstract
INTRODUCTION Transperineal prostate (TP) biopsy has emerged as a substantial alternative to the conventional transrectal (TR) approach for prostate sampling by its ability to sample specific areas of the prostate more effectively. The objective of this review is to conduct a comparative analysis of the current literature regarding diagnostic accuracy, complication rate and clinical outcome of transrectal vs. transperineal approaches in prostate biopsy-naïve patients and in repeated biopsy scenarios. MATERIALS AND METHODS An extensive search of the literature in PubMed, Scopus, and Web of Science was conducted between September 2010 and September 2024. We utilized a robust and comprehensive retrieval strategy including phrasing the two approaches as follows: (perineal or transperineal) and (rectal or transrectal). CONCLUSIONS The transperineal and transrectal approaches show similar results in the detection of PCa in biopsy-naïve men, similar rates of infection, urinary retention and effectiveness managing biopsy-associated pain. However, in the rebiopsy scenario, the TP approach has demonstrated increased accuracy compared to the TR approach. This has significant implications in decision making and patient counselling.
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Affiliation(s)
| | - Cristian Mirvald
- Centre for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.D.); (I.S.)
- Faculty of General Medicine, Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandru Danilov
- Centre for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.D.); (I.S.)
| | | | - Adrian George Vlaicu
- Department of Urology, “CF2” Hospital, 011464 Bucharest, Romania; (A.G.V.); (L.G.)
| | - Leonardo Giurca
- Department of Urology, “CF2” Hospital, 011464 Bucharest, Romania; (A.G.V.); (L.G.)
| | - Ioanel Sinescu
- Centre for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.D.); (I.S.)
- Faculty of General Medicine, Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Surcel
- Centre for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.D.); (I.S.)
- Faculty of General Medicine, Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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10
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Zattoni F, Novara G, Dal Moro F, Tandogdu Z. Prostate Biopsy: The Transperineal Approach Is Better! Eur Urol Focus 2025:S2405-4569(25)00054-9. [PMID: 40037972 DOI: 10.1016/j.euf.2025.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 01/31/2025] [Accepted: 02/21/2025] [Indexed: 03/06/2025]
Abstract
Transperineal prostate biopsy offers advantages over transrectal biopsy in terms of cancer detection in specific prostate areas, potential use of larger-gauge needles for tissue sampling, a lower risk of severe infectious complications such as sepsis, and lower use of antibiotic prophylaxis, aligning with antibiotic stewardship policies and reducing the risk of antimicrobial resistance and gut microbiome changes.
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Affiliation(s)
- Fabio Zattoni
- Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy; Department of Medicine, University of Padua, Padua, Italy.
| | - Giacomo Novara
- Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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Zattoni F, Novara G, Dal Moro F, Tandogdu Z. Prostate Biopsy: The Transperineal Approach is Better! Eur Urol Focus 2025:S2405-4569(25)00050-1. [PMID: 40037974 DOI: 10.1016/j.euf.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/13/2025] [Accepted: 02/20/2025] [Indexed: 03/06/2025]
Abstract
Transperineal prostate biopsy offers advantages over transrectal biopsy in terms of cancer detection in specific prostate areas, potential use of larger-gauge needles for tissue sampling, a lower risk of severe infectious complications such as sepsis, and lower use of antibiotic prophylaxis, aligning with antibiotic stewardship policies and reducing the risk of antimicrobial resistance and gut microbiome changes.
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Affiliation(s)
- Fabio Zattoni
- Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy; Department of Medicine, University of Padua, Padua, Italy.
| | - Giacomo Novara
- Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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12
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Hesswani C, Avolio PP, Rompre-Brodeur A, Ghai S, Anidjar M, Kinnaird A, Chin J, Perlis N, Soytas M, Mannas M, Ahmad A, Klotz L, Tanguay S, Kassouf W, McPherson V, Aprikian A, Pinto P, Sanchez-Salas R. Navigating Focal Therapy for Prostate Cancer: Contemporary Perspectives and Future Trajectories in the Canadian Context. J Endourol 2025; 39:S29-S37. [PMID: 39612186 PMCID: PMC11971556 DOI: 10.1089/end.2024.0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024] Open
Abstract
Objective: This article equips Canadian urologists with the latest advancements in focal therapy (FT) principles and outcomes while providing an overview of its current landscape in Canada, including challenges and future directions. Methods: We conducted a nonsystematic review of the literature on FT in urology and prostate cancer (PCa), focusing on Canadian-led studies. Articles were identified using PubMed, MEDLINE, and Google Scholar and selected based on relevance and originality. The final search was completed in April 2024. A survey was also conducted among Canadian urologists and radiologists practicing FT. It covered their experiences, access to technology, implementation challenges, and reimbursement policies. Data were collected via video calls, phone calls, or email, and responses were reported anonymously. Results: Fourteen Canadian urologists and radiologists performing FT were contacted, and 12 participated in this study. Despite the increasing adoption of FT by Canadian urologists, nationwide implementation remains limited due to financial constraints and resource shortages. This has restricted the availability of FT for Canadian men with PCa compared with their American and European counterparts. Only two provinces-Saskatchewan and Alberta-currently have billing codes for FT, forcing patients elsewhere to either join clinical trials or pay out of pocket. To close this care gap, equitable health care coverage and integration of FT into standard treatment options are essential. Conclusion: The quality of research in FT is showing promising improvements, with several clinical trials currently underway that may pave the way for broader acceptance within clinical guidelines by multiple urological societies. Although Canada has been slower to adopt FT compared with other parts of the world, Canadian urologists continue to advocate for provincial health care coverage to ensure that this innovative technology becomes accessible to Canadian patients.
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Affiliation(s)
- Charles Hesswani
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Pier-Paolo Avolio
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Alexis Rompre-Brodeur
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Sangeet Ghai
- Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Adam Kinnaird
- Division of Urology, University of Alberta, Edmonton, Canada
| | - Joseph Chin
- Division of Urology, Department of Surgery, Western University, London, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, University Health Network, Toronto, Canada
| | - Mostapha Soytas
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Miles Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | | | - Lawrence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simon Tanguay
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Victor McPherson
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
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13
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Wolff I, Büchner M, Hauner K, Wagenlehner F, Burchardt M, Abele-Horn M, Wullich B, Gilfrich C, Pilatz A, May M. Infectious complications following transperineal prostate biopsy with or without periprocedural antibiotic prophylaxis-a systematic review including meta-analysis of all comparative studies. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00934-9. [PMID: 39741175 DOI: 10.1038/s41391-024-00934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/12/2024] [Accepted: 12/19/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND Despite the relatively low infection rate following transperineal prostate biopsy (TPB), it remains unresolved whether periprocedural antibiotic prophylaxis (PAP) can be omitted. Our aim was to compare infectious complications (genitourinary infections/GUI, fever, sepsis, readmission rate, 30-day-mortality) following TPB, considering all studies of varying levels of evidence that enable a direct comparison between patients with and without PAP. METHODS We performed a comprehensive search in PubMed/Medline, Embase, Web of Science, and Cochrane databases, as well as grey literature sources, to identify reports published until January 2024. All studies comparing the incidence of infectious endpoints following TPB with vs. without PAP were included in the analyses. The GRADE approach was employed to assess the certainty of evidence for each comparison. RESULTS Twenty-three studies met the inclusion criteria involving 6520 and 5804 patients who underwent TPB with vs. without PAP, respectively. Two of the 23 studies were randomized-controlled trials, not all studies investigated all endpoints. Pooled incidences between patients with vs. without PAP for the endpoints GUI (0.50% vs. 0.37%), fever (0.44% vs. 0.26%), sepsis (0.16% vs. 0.13%), and readmission rate (0.35% vs. 0.29%) showed no significant differences (all p > 0.250). The corresponding odds ratios (including 95% confidence interval) also revealed no statistically significant differences: 1.37 (0.74-2.54) [GUI], 0.87 (0.28-2.66) [fever], 1.30 (0.46-3.67) [sepsis], and 1.45 (0.70-3.03) [readmission rate]. No study reported events regarding 30-day-mortality. In subgroup analyses and sensitivity analyses, TPB without PAP showed no significantly higher complication rates regarding all analyzed endpoints. CONCLUSIONS Infectious complications after TPB occur very rarely and cannot be further reduced by PAP. Considering the results of this systematic review and adhering to the principles of effective antibiotic stewardship, omitting PAP in the context of TPB is advisable.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany.
| | - Markus Büchner
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Katharina Hauner
- Department of Urology, School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Martin Burchardt
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Marianne Abele-Horn
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
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14
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Lamb AD, Landeiro F, Marian IR, Tuck S, Bryant RJ. Evidence for local anaesthetic transperineal biopsy versus transrectal prostate biopsy. BMJ 2024; 387:e078175. [PMID: 39622548 DOI: 10.1136/bmj-2023-078175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Affiliation(s)
- Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, UK
- Department of Urology, Oxford University NHS Foundation Trust
| | - Filipa Landeiro
- Nuffield Department of Population Health, University of Oxford
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit (OCTRU) Centre for Statistics in Medicine (CSM), University of Oxford
| | - Steve Tuck
- Oxford Prostate Cancer Support Group, Oxford
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, UK
- Department of Urology, Oxford University NHS Foundation Trust
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15
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Abdulrasheed H, George AO, Ayobami-Ojo PS, Rai P, Nwachukwu NO, Ajimoti A, Alawadi A, Iftikhar CZ, Mehreen A, Mbisa A. Comparing the Efficacy and Safety of the Transperineal Versus Transrectal Prostate Biopsy Approach in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e75459. [PMID: 39791029 PMCID: PMC11716271 DOI: 10.7759/cureus.75459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2024] [Indexed: 01/12/2025] Open
Abstract
Prostate cancer (PCa) has high prevalence rates in men and is a leading cause of cancer-related death. Transrectal (TR) biopsy has traditionally been the gold standard for diagnosis, but transperineal (TP) biopsy is increasingly favoured due to its lower infection risk. However, debate remains regarding which method has superior cancer detection rates. This review compares the efficacy and safety of the TP as compared to the TR prostate biopsy approach, summarizing the largest body of evidence available to date. A literature search was performed on the PubMed, Google Scholar, Cochrane Library, and Embase databases. We searched from the inception of the databases up to August 2024 for relevant studies comparing the cancer detection rate of TP versus TR prostate biopsy and compared their complication rates. Twenty-one studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences between the TR and TP groups in the PCa detection rate. This meta-analysis included 21 studies (6 randomized control trials and 15 cohort studies) with a total of 13,818 patients (TP = 7917; TR = 5901), who were accrued between 2008 and 2024 and divided into the TR group and the TP group. The analysis revealed no significant difference in prostate cancer detection rates between the TP and TR approaches in both RCTs (OR 1.02, 95% CI (0.74, 1.41), p = 0.90) and cohort studies (OR 1.07, 95% CI (0.85, 1.35), p = 0.36). Complication profiles were largely comparable; TP demonstrated a significantly lower risk of urinary tract infections (OR 0.26, 95% CI (0.11, 0.61)) but no notable differences in acute urinary retention, haematuria, or rectal bleeding. Our findings advocate the TP approach as a safer biopsy alternative where feasible, particularly in infection-sensitive populations, without compromising diagnostic accuracy. MRI should complement biopsy strategies to enhance diagnostic precision. Future research should focus on standardized, large-scale RCTs to further refine and personalize prostate cancer diagnostic pathways.
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Affiliation(s)
| | | | | | - Pratik Rai
- Urology, University Hospital Birmingham, Birmingham, GBR
| | | | | | | | | | - Aaisha Mehreen
- Urology, University Hospital Birmingham, Birmingham, GBR
| | - Asante Mbisa
- Urology, University Hospital Birmingham, Birmingham, GBR
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16
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Lin FX, Yu Y, Xu ZP. Re: Guillaume Ploussard, Eric Barret, Gaëlle Fiard, et al. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsies for Prostate Cancer Diagnosis: Final Results of the Randomized PERFECT trial (CCAFU-PR1). Eur Urol Oncol. In press. https://doi.org/ 10.1016/j.euo.2024.01.019. Eur Urol Oncol 2024; 7:1549-1550. [PMID: 38772750 DOI: 10.1016/j.euo.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Fu-Xiang Lin
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, People's Republic of China
| | - Yi Yu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, People's Republic of China
| | - Zhan-Ping Xu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, People's Republic of China.
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17
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Zattoni F, Rajwa P, Miszczyk M, Fazekas T, Carletti F, Carrozza S, Sattin F, Reitano G, Botti S, Matsukawa A, Dal Moro F, Jeffrey Karnes R, Briganti A, Novara G, Shariat SF, Ploussard G, Gandaglia G. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Prostate Biopsy: A Systematic Review and Meta-analysis of Prospective Studies. Eur Urol Oncol 2024; 7:1303-1312. [PMID: 39095298 DOI: 10.1016/j.euo.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND OBJECTIVE The benefits of the detection of clinically significant prostate cancer (csPCa) and safety of magnetic resonance imaging (MRI)-targeted transperineal (TP) prostate biopsy (TP-Tbx) versus transrectal (TR) approaches are still a matter of debate. This review aims to compare the efficacy and safety of TP-Tbx and MRI-targeted TR biopsy (TR-Tbx). METHODS A systematic literature search was performed in PubMed/Medline, Scopus, and Web of Science to identify records of prospective randomized controlled trials (RCTs) comparing TP-Tbx and TR-Tbx published until May 2024. The primary outcomes included detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥2) and rates of complications. KEY FINDINGS AND LIMITATIONS Three RCTs (PREVENT, ProBE-PC, and PERFECT) met the inclusion criteria. The TR technique was commonly administered with antibiotic prophylaxis to mitigate infection risks or after a rectal swab. No difference was found between TP-Tbx and TR-Tbx in terms of either csPCa (odds ratio [OR] 0.9, 95% confidence interval [CI]: 0.7-1.1) or ISUP 1 prostate cancer (PCa; OR 1.1, 95% CI: 0.8-1.4) detection. Postprocedural infection (OR 0.8, 95% CI: 0.4-1.8), sepsis (OR 0.6, 95% CI: 0.1-4.5), and urinary retention rates (OR 0.5, 95% CI: 0.1-1.6) were similar. Pain during the TP approach was slightly higher than during the TR approach, but after 7 d of follow-up, the differences between the two approaches were minimal. Variations in biopsy numbers per patient, patient selection, use of 5-alpha reductase inhibitors, needle sizes, TP techniques, and pain scores (reported in only one RCT), along with the multicenter nature of RCTs, limit the study. CONCLUSIONS AND CLINICAL IMPLICATIONS TP-Tbx and TR-Tbx show similar results in detecting PCa, with comparable rates of infections, urinary retention, and effectiveness in managing biopsy-associated pain. TP-Tbx can safely omit antibiotics without increasing infection risk, unlike TR-Tbx. The tendency to exclude from practice TR-Tbx with prophylactic antibiotics due to infection concerns could be moderated; however, the directionality of some key outcomes, as infections and sepsis, favor the TP approach despite a lack of statistical significance. PATIENT SUMMARY There were no significant differences in the prostate biopsy approaches (transperineal [TP] vs transrectal [TR]) for prostate cancer detection and complications. However, the MRI-targeted TP prostate biopsy approach may be advantageous as it can be performed safely without antibiotics, potentially reducing antibiotic resistance.
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Affiliation(s)
- Fabio Zattoni
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy; Department of Medicine - DIMED, University of Padua, Padua, Italy.
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Miszczyk
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland
| | - Tamás Fazekas
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Semmelweis University, Budapest, Hungary
| | - Filippo Carletti
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Salvatore Carrozza
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Francesca Sattin
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Giuseppe Reitano
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Simone Botti
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Akihiro Matsukawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Semmelweis University, Budapest, Hungary; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Research Center for Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Malshy K, Osinski T, Hunt TC, Joseph J. Letter to the editor: transrectal versus transperineal prostate fusion biopsy-a pair-matched analysis to evaluate accuracy and complications. World J Urol 2024; 42:622. [PMID: 39495355 DOI: 10.1007/s00345-024-05328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 11/05/2024] Open
Affiliation(s)
- Kamil Malshy
- The Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Thomas Osinski
- The Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Trevor C Hunt
- The Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Jean Joseph
- The Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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19
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He Z, Wang C, Tian H. Letter to the editor for the article "Transrectal versus transperineal prostate fusion biopsy: a pair-matched analysis to evaluate accuracy and complications". World J Urol 2024; 42:623. [PMID: 39496925 DOI: 10.1007/s00345-024-05331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 10/20/2024] [Indexed: 11/06/2024] Open
Affiliation(s)
- Ziyi He
- Department of Oncology, The Second Affiliated Hospital of Tianjin University of Chinese Medicine, Tianjin, 300250, China
| | - Chenxi Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, 999078, China
| | - Huichuan Tian
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, 999078, China.
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20
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Piccolini A, Avolio PP, Saitta C, Beatrici E, Moretto S, Aljoulani M, Dagnino F, Maffei D, Frego N, Fasulo V, Paciotti M, Hurle R, Saita A, Lazzeri M, Casale P, Colombo P, Cieri M, Buffi NM, Lughezzani G. A Propensity Score-matched Comparison of Micro-ultrasound-guided Transrectal and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion-guided Transperineal Prostate Biopsies for Detection of Clinically Significant Prostate Cancer. EUR UROL SUPPL 2024; 69:7-12. [PMID: 39314912 PMCID: PMC11417145 DOI: 10.1016/j.euros.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2024] [Indexed: 09/25/2024] Open
Abstract
Background and objective High-resolution micro-ultrasound (microUS) is an advanced imaging tool. Our objective was to determine whether systematic microUS use for transrectal biopsy (TRBx) improves the detection rate for clinically significant prostate cancer (csPCa) in comparison to transperineal biopsy (TPBx) performed with magnetic resonance imaging (MRI)/conventional transrectal ultrasound (TRUS) fusion software. Methods We retrospectively analyzed data for men who underwent prostate biopsies, including those on active surveillance (AS). TRBx was performed under microUS guidance, while MRI/TRUS fusion was consistently used to guide TPBx. Patients were matched according to propensity score matching (PSM). The primary endpoint was comparison of the csPCa detection rate with the two approaches. Secondary endpoints included predictors of csPCa (International Society of Urological Pathology grade group ≥2, assessed via multivariable logistic regression) and complication rates. Key findings and limitations Overall, 1423 patients were enrolled. After applying PSM we identified an analytical cohort of 1094 men, 582 in the TRBx group and 512 in the TPBx group. There was no significant difference in the csPCa detection rate between the TRBx (45%) and TPBx (51%) groups (p = 0.07). Complications occurred in nine of 1094 patients (1%). On adjusted multivariable analysis, TPBx had a similar csPCa detection rate to TRBx (adjusted odds ratio [aOR] 1.26;p = 0.09). Predictors of csPCa detection were a positive family history (aOR 1.68; 95% confidence interval [CI] 1.20-2.35; p = 0.002); age (aOR 1.04, 95% CI 1.02-1.06; p < 0.001); positive digital rectal examination (aOR 2.35, 95% CI 1.70-3.25; p < 0.001); prostate-specific antigen density ≥0.15 ng/ml/cm3 (aOR 3.23, 95% CI 2.47-4.23; p < 0.001); and a Prostate Imaging-Reporting and Data System score ≥3 (aOR 2.46; 95% CI 1.83-3.32; p < 0.001). Limitations include the retrospective nature of the study, the risk of underestimating the complication rate, and the heterogeneity of biopsy indications. Conclusions and clinical implications TRBx using microUS alone showed a comparable csPCa detection rate to TPBx guided by MRI/TRUS fusion software. Given the better visualization and real-time detection of suspicious zones with microUS, the potential for improvement in the csPCa detection rate with greater integration of microUS in the TPBx setting warrants further investigation. Patient summary We compared the ability of two different prostate biopsy approaches to detect clinically significant prostate cancer. We found that transrectal biopsy guided by micro-ultrasound had similar detection rates to transperineal biopsy guided by a combination of magnetic resonance imaging and conventional ultrasound. More research is needed to confirm the potential of micro-ultrasound for transperineal biopsy.
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Affiliation(s)
- Andrea Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Edoardo Beatrici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefano Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Muhannad Aljoulani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Filippo Dagnino
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Miriam Cieri
- Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
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21
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Boesen L, Chapin BF. Re: Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial. Eur Urol 2024; 86:479-480. [PMID: 39043550 DOI: 10.1016/j.eururo.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/10/2024] [Indexed: 07/25/2024]
Affiliation(s)
- Lars Boesen
- Department of Urology and Urological Research, Herlev Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Brian F Chapin
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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22
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Hubner N, Dall'Era M. Preventing Infections After Prostate Biopsy: Prophylactic Antibiotics, Prebiopsy Rectal Culture, and Biopsy Approach. Urol Clin North Am 2024; 51:439-444. [PMID: 39349012 DOI: 10.1016/j.ucl.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Prostate biopsies are commonly performed for the early detection of prostate cancer and yet are associated with risks of life-threatening infections. Drug-resistant strains of Escherichia coli are the most common etiologic agents. Multiple maneuvers can reduce the risk of postbiopsy infections and sepsis during transrectal prostate biopsy including periprocedural empiric or targeted prophylactic antibiotics (based on previous rectal culture) and prebiopsy rectal cleansing with a povidone-iodine solution. The transperineal approach is associated with a very low risk of infection without requiring antibiotic prophylaxis.
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Affiliation(s)
- Nicolai Hubner
- Department of Urologic Surgery, University of California, Davis, 4860 Y Street, Suite 3500, Sacramento, CA 95817, USA
| | - Marc Dall'Era
- Department of Urologic Surgery, University of California, Davis, 4860 Y Street, Suite 3500, Sacramento, CA 95817, USA.
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23
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Ploussard G, Baboudjian M, Barret E, Brureau L, Fiard G, Fromont G, Olivier J, Dariane C, Mathieu R, Rozet F, Peyrottes A, Roubaud G, Renard-Penna R, Sargos P, Supiot S, Turpin L, Rouprêt M. French AFU Cancer Committee Guidelines - Update 2024-2026: Prostate cancer - Diagnosis and management of localised disease. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102717. [PMID: 39581668 DOI: 10.1016/j.fjurol.2024.102717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 11/26/2024]
Abstract
OBJECTIVE The aim of the Oncology Committee of the French Urology Association is to propose updated recommendations for the diagnosis and management of localized prostate cancer (PCa). METHODS A systematic review of the literature from 2022 to 2024 was conducted by the CCAFU on the elements of diagnosis and therapeutic management of localized PCa, evaluating references with their level of evidence. RESULTS The recommendations set out the genetics, epidemiology and diagnostic methods of PCa, as well as the concepts of screening and early detection. MRI, the reference imaging test for localized cancer, is recommended before prostate biopsies are performed. Molecular imaging is an option for disease staging. Performing biopsies via the transperineal route reduces the risk of infection. Active surveillance is the standard treatment for tumours with a low risk of progression. Therapeutic methods are described in detail, and recommended according to the clinical situation. CONCLUSION This update of French recommendations should help to improve the management of localized PCa.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France; Department of Radiotherapy, Institut Curie, Paris, France.
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail (Irset), UMR_S 1085, 97110 Pointe-à-Pitre, Guadeloupe
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | | | - Charles Dariane
- Department of Urology, Hôpital européen Georges-Pompidou, AP-HP, Paris, France; Paris University, U1151 Inserm, INEM, Necker, Paris, France
| | | | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France
| | - Raphaële Renard-Penna
- Sorbonne University, AP-HP, Radiology, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France
| | - Stéphane Supiot
- Radiotherapy Department, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Léa Turpin
- Nuclear Medicine Department, Hôpital Foch, Suresnes, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, 75013 Paris, France
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24
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Ononye R, Roberts J, Igbokwe K, Adebisi AA, Adefehinti M. Outcomes of Systematic Transrectal Ultrasound-Guided Prostate Biopsy Performed by a Surgical Care Practitioner and Implications for Resource-Poor Countries. Cureus 2024; 16:e74488. [PMID: 39726450 PMCID: PMC11670409 DOI: 10.7759/cureus.74488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2024] [Indexed: 12/28/2024] Open
Abstract
Introduction Prostate cancer remains the most prevalent cancer among men and continues to present a significant public health challenge globally. The disease's growing prevalence has heightened the demand for skilled professionals capable of obtaining histological samples for accurate diagnosis, as tissue biopsy remains the cornerstone for diagnosing prostate cancer. Surgical care practitioners have become integral to the surgical team, and their roles have expanded to include performing biopsies. This paper evaluates the outcomes of transrectal ultrasound-guided (TRUS) prostate biopsies conducted by a surgical care practitioner (SCP) and explores the implications for resource-poor countries. Methods We retrospectively collated data from 218 patients who underwent TRUS prostate systematic biopsy by a surgical care practitioner between 2020 and 2022. We evaluated the prostate-specific antigen (PSA) values, MRI Likert score where available, and histological data and determined diagnostic yield and complication rates. Results The mean age and PSA level of the men were 69.7 years and 61.2 ng/ml, respectively; an average of 12 cores were obtained per biopsy. The cancer detection rate was 128/218 (59%), with a mean Gleason grade of 2.8. From available MRI, Likert 3 was the most common finding, 45/103 (43.6%), and prostate cancer was found in 40%. The mean MRI Likert scores for a positive and negative biopsy were 4 and 3.3, respectively. We recorded three complications (1%), all Clavien-Dindo 1 to 2, with no mortality. Conclusion A well-trained, supported, and supervised surgical care practitioner can safely and effectively perform TRUS systematic prostate biopsies and may improve access to prostate cancer diagnosis in developing countries.
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Affiliation(s)
| | - Joanne Roberts
- Urological Surgery, Glan Clwyd Hospital, Bodelwyddan, GBR
| | - Kenechukwu Igbokwe
- Trauma and Orthopaedics, Gateshead Health NHS Foundation Trust, Gateshead, GBR
| | - Ajibola A Adebisi
- General Surgery, Epsom and St. Helier University NHS Foundation Trust, London, GBR
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25
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Ghoreifi A, Gomella L, Hu JC, Konety B, Lunelli L, Rastinehad AR, Salomon G, Taneja S, Tourinho-Barbosa R, Lebastchi AH. Identifying the best candidate for focal therapy: a comprehensive review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00907-y. [PMID: 39443815 DOI: 10.1038/s41391-024-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/25/2024] [Accepted: 10/03/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Despite the evidence supporting the use of focal therapy (FT) in patients with localized prostate cancer (PCa), considerable variability exists in the patient selection criteria across current studies. This study aims to review the most recent evidence concerning the optimal approach to patient selection for FT in PCa. METHODS PubMed database was systematically queried for studies reporting patient selection criteria in FT for PCa before December 31, 2023. After excluding non-relevant articles and a quality assessment, data were extracted, and results were described qualitatively. RESULTS There is no level I evidence regarding the best patient selection approach for FT in patients with PCa. Current international multidisciplinary consensus statements recommend multiparametric magnetic resonance imaging (mpMRI) followed by MRI-targeted and systematic biopsy for all candidates. FT may be considered in clinically localized, intermediate risk (Gleason 3 + 4 and 4 + 3), and preferably unifocal disease. Patients should have an acceptable life expectancy. Those with prostate volume >50 ml and erectile dysfunction should not be excluded from FT. Prostate-specific antigen (PSA) level of < 20 (ideally < 10) ng/mL is recommended. However, the utility of other molecular and genomic biomarkers in patient selection for FT remains unknown. CONCLUSIONS FT may be considered in well-selected patients with localized PCa. This review provides a comprehensive insight regarding the optimal approach for patient selection in FT.
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Affiliation(s)
- Alireza Ghoreifi
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Leonard Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Badrinath Konety
- Allina Health Cancer Institute, Minneapolis, Minneapolis, MN, USA
| | - Luca Lunelli
- Department of Urology, Hospital Louis Pasteur, Chartres, France
| | | | - Georg Salomon
- Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samir Taneja
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Amir H Lebastchi
- Department of Urology, University of Southern California, Los Angeles, CA, USA.
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26
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Oderda M, Diamand R, Abou Zahr R, Anract J, Assenmacher G, Barry Delongchamps N, Bui AP, Benamran D, Calleris G, Dariane C, Ferriero M, Fiard G, Taha F, Fourcade A, Fournier G, Guenzel K, Halinski A, Marra G, Ploussard G, Rysankova K, Roche JB, Simone G, Windisch O, Gontero P. Transrectal versus transperineal prostate fusion biopsy: a pair-matched analysis to evaluate accuracy and complications. World J Urol 2024; 42:535. [PMID: 39320521 PMCID: PMC11424653 DOI: 10.1007/s00345-024-05245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/24/2024] [Indexed: 09/26/2024] Open
Abstract
PURPOSE To evaluate biopsy-related complications and detection rates of any PCa and clinically significant PCa (csPCa, intended as grade group ≥ 2) between MRI-targeted TP fusion biopsies (TPBx) and TR ones (TRBx). METHODS We performed a multicentric study on 4841 patients who underwent fusion biopsy between 2016 and 2023. A case-control matching was performed to find comparable cohorts of 646 TPBx and 646 TRBx. Mean T test and Pearson chi-square tests were used to compare continuous and categorical variables. RESULTS Baseline characteristics were comparable between the cohorts, except for target location with a higher rate of anterior lesions in TPBx group. Complications were rare and no difference was found between the groups, with similar rates of infections after TRBx and TPBx (N = 5 (0.8%) vs N = 2 (0.3%), p 0.45). All patients in TRBx and 90.1% in TPBx group received antibiotic prophylaxis. A higher csPCa detection rate was found in TPBx over the group (50.5% vs 36.2%, p < 0.001). On average, positive targeted cores were increased in TPBx group, for any PCa (1.6 vs 1.4, p 0.04) and csPCa (1.0 vs 0.8, p 0.02). Among the limitations of study, we acknowledge the retrospective design and the possible under-reporting of complications. CONCLUSIONS MRI-targeted fusion TPBx achieves a significantly higher csPCa detection than TRBx, with a diagnostic advantage for apical and anterior lesions. No significant differences were found in terms of complications that were rare in both groups, considering a widespread adoption of antibiotic prophylaxis.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy.
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Rawad Abou Zahr
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Julien Anract
- Division of Urology, Cochin Hospital, APHP, Paris Cité University, Paris, France
| | | | | | | | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | | | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | - Fayek Taha
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Karsten Guenzel
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Adam Halinski
- Department of Urology, Private Medical Center, Klinika Wisniowa", Zielona Góra, Poland
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | | | - Katerina Rysankova
- Department of Urology and Surgical Studies, Faculty of Medicine, University Hospital Ostrava, Ostrava University, Ostrava, Czech Republic
| | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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27
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Madhavan K, Bhargava P, Phonde A, Yadav S, Kumar Plash S, Kumar Kadlepla Mutt P, Madhavan M, Kaushal D, Jena R. Preventing Infectious Complications Following Prostate Biopsy: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials of Alternative Approaches to Transrectal Biopsy with Empirical Antibiotic Prophylaxis Therapy. Eur Urol Focus 2024:S2405-4569(24)00179-2. [PMID: 39327218 DOI: 10.1016/j.euf.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/22/2024] [Accepted: 09/17/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostate biopsy, conducted frequently through the transrectal route, is associated with significant risks of infectious complications. This study aimed to compare the efficacy of various strategies to reduce these complications, using a network meta-analysis approach. METHODS Our study included randomized controlled trials (RCTs) identified from PubMed/MEDLINE, Embase, and the Cochrane database as of March 1, 2024. We included studies that involved adults undergoing transrectal or transperineal prostate biopsy with either standard empirical antibiotic prophylaxis or alternative interventions. The primary outcomes were assessment of sepsis, fever, urinary tract infections (UTIs), and readmissions. The study was registered with PROSPERO (CRD42024532225). KEY FINDINGS AND LIMITATIONS Our search yielded 28 RCTs eligible for analysis, encompassing a total of 10 179 participants. Rectal cleansing had the highest rankogram score to reduce infectious complications such as sepsis (odds ratio 0.40, 95% confidence interval [0.28-0.58]; rankogram, p score = 0.917), followed by transperineal biopsy (p score = 0.496). The overall analysis also highlighted a lower incidence of UTIs and readmissions with this method. Heterogeneity among studies was minimal (I2 < 50% for all outcomes). CONCLUSIONS AND CLINICAL IMPLICATIONS Rectal cleansing might be the most effective strategy to reduce infectious complications following transrectal prostate biopsy and could be more effective than rectal culture-based antibiotic prophylaxis and transperineal biopsy. Given the indirect nature of our comparisons, further RCTs are needed to determine the safest approach for prostate biopsy, particularly between transperineal biopsy and transrectal biopsy with rectal cleansing or rectal culture-based antibiotic prophylaxis. PATIENT SUMMARY In this review, we analyzed different techniques to reduce infectious complications after a prostate biopsy. We found that rectal cleansing prior to performing a transrectal prostate biopsy reduced infectious complications and might be the most effective strategy. We conclude that either transperineal or transrectal prostate biopsies are acceptable approaches, albeit with rectal cleansing or rectal culture-based antibiotic prophylaxis, respectively.
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Affiliation(s)
| | | | - Amrut Phonde
- All India Institute of Medical Sciences, Bhopal, India
| | - Sagar Yadav
- All India Institute of Medical Sciences, Bhopal, India
| | | | | | | | | | - Rahul Jena
- Bagchi Sri Shankara Cancer Centre and Research Institute, Bhubaneswar, India.
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28
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Pilatz A, Stangl F, Kranz J, Bonkat G, Veeratterapillay R. Transperineal Is the Way To Go. Eur Urol Focus 2024; 10:691-693. [PMID: 38972794 DOI: 10.1016/j.euf.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
The evidence available shows that transperineal prostate biopsy is significantly superior to transrectal biopsy in terms of infectious complications and is therefore recommended as the first choice in the European Association of Urology guidelines.
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Affiliation(s)
- Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.
| | - Fabian Stangl
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Kranz
- Department of Urology and Pediatric Urology, University Medical Center RWTH Aachen, Aachen, Germany; Department of Urology and Kidney Transplantation, Martin-Luther University, Halle, Germany
| | - Gernot Bonkat
- alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of Basel, Basel, Switzerland
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29
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Busshoff I, Haidl F, Radtke JP, Albers P. Prostate Biopsy: The Transrectal Approach Is Safe. Eur Urol Focus 2024; 10:688-690. [PMID: 39505658 DOI: 10.1016/j.euf.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/21/2024] [Accepted: 09/11/2024] [Indexed: 11/08/2024]
Abstract
A targeted transrectal biopsy with antibiotic prophylaxis is an effective alternative for patients who do not have access to transperineal biopsy. Transrectal biopsy remains a safe and straightforward method that should continue to be used.
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Affiliation(s)
- Isabelle Busshoff
- Department of Urology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Friederike Haidl
- Department of Urology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Philipp Radtke
- Department of Urology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
| | - Peter Albers
- Department of Urology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Personalized Early Detection of Prostate Cancer, German Cancer Research Centre, Heidelberg, Germany
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30
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Ramacciotti LS, Strauss D, Cei F, Kaneko M, Mokhtar D, Cai J, Jadvar D, Cacciamani GE, Aron M, Halteh PB, Duddalwar V, Gill I, Abreu AL. Transperineal versus Transrectal MRI/TRUS fusion-guided prostate biopsy in a large, ethnically diverse, and multiracial cohort. Int Braz J Urol 2024; 50:616-628. [PMID: 39106117 PMCID: PMC11446557 DOI: 10.1590/s1677-5538.ibju.2024.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/06/2024] [Indexed: 08/09/2024] Open
Abstract
PURPOSE To compare transperineal (TP) vs transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion-guided prostate biopsy (PBx) in a large, ethnically diverse and multiracial cohort. MATERIALS AND METHODS Consecutive patients who underwent multiparametric (mp) MRI followed by TP or TR TRUS-fusion guided PBx, were identified from a prospective database (IRB #HS-13-00663). All patients underwent mpMRI followed by 12-14 core systematic PBx. A minimum of two additional target-biopsy cores were taken per PIRADS≥3 lesion. The endpoint was the detection of clinically significant prostate cancer (CSPCa; Grade Group, GG≥2). Statistical significance was defined as p<0.05. RESULTS A total of 1491 patients met inclusion criteria, with 480 undergoing TP and 1011 TR PBx. Overall, 11% of patients were Asians, 5% African Americans, 14% Hispanic, 14% Others, and 56% White, similar between TP and TR (p=0.4). For PIRADS 3-5, the TP PBx CSPCa detection was significantly higher (61% vs 54%, p=0.03) than TR PBx, but not for PIRADS 1-2 (13% vs 13%, p=1.0). After adjusting for confounders on multivariable analysis, Black race, but not the PBx approach (TP vs TR), was an independent predictor of CSPCa detection. The median maximum cancer core length (11 vs 8mm; p<0.001) and percent (80% vs 60%; p<0.001) were greater for TP PBx even after adjusting for confounders. CONCLUSIONS In a large and diverse cohort, Black race, but not the biopsy approach, was an independent predictor for CSPCa detection. TP and TR PBx yielded similar CSPCa detection rates; however the TP PBx was histologically more informative.
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Affiliation(s)
- Lorenzo Storino Ramacciotti
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineCenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate CancerLos AngelesCaliforniaUSACenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David Strauss
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineCenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate CancerLos AngelesCaliforniaUSACenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Francesco Cei
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Masatomo Kaneko
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineCenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate CancerLos AngelesCaliforniaUSACenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel Mokhtar
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jie Cai
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Delara Jadvar
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineCenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate CancerLos AngelesCaliforniaUSACenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Giovanni E. Cacciamani
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaDepartment of Radiology Keck School of MedicineLos AngelesCaliforniaUSADepartment of Radiology Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Manju Aron
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaDepartment of Pathology Keck School of MedicineLos AngelesCaliforniaUSADepartment of Pathology Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Pierre B. Halteh
- University of Southern CaliforniaDepartment of Radiology Keck School of MedicineLos AngelesCaliforniaUSADepartment of Radiology Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Vinay Duddalwar
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaDepartment of Radiology Keck School of MedicineLos AngelesCaliforniaUSADepartment of Radiology Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Inderbir Gill
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andre Luis Abreu
- University of Southern CaliforniaKeck School of MedicineUSC Institute of UrologyLos AngelesCaliforniaUSAUSC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineCenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate CancerLos AngelesCaliforniaUSACenter for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaDepartment of Radiology Keck School of MedicineLos AngelesCaliforniaUSADepartment of Radiology Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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31
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Berridge C, Omer A, Lopez F, Bryant RJ, Lamb AD. Perspectives on technology - prostate cancer: is local anaesthetic transperineal prostate biopsy really better than transrectal biopsy? BJU Int 2024; 134:166-174. [PMID: 38584582 DOI: 10.1111/bju.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
For many years, transrectal ultrasound-guided (TRUS) prostate biopsies have been performed to establish a histological diagnosis of prostate cancer. This has been the recommended standard of care procedure, but has always carried risks, in particular the risk of post-procedural sepsis, and the associated antibiotic burden and risk of development of antibiotic resistance. Transperineal (TP) prostate biopsies performed under local anaesthetic (LA) have been proposed as a possible solution to these issues, with potentially lower infectious complications, and avoidance of need for antibiotic prophylaxis. The European Association of Urology produced guidance in 2023 with 'weak' recommendations in favour of LATP biopsy as a new standard of care, citing its safety profile. Both the National Institute for Health and Care Excellence in the UK, and the American Urological Association in the United States, have concluded for now that the body of evidence is inadequate and not offered a similar recommendation. We discuss the available evidence, pros and cons of each technique, and the status of current trials in the field. We believe that clinical equipoise remains necessary, given the disparity in national and international guidelines highlighting the need for large randomised controlled trials to answer the question: is LATP biopsy really better than TRUS biopsy?
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Affiliation(s)
- Christopher Berridge
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Hoeh B, Wenzel M, Humke C, Cano Garcia C, Siech C, Schneider M, Lange C, Traumann M, Köllermann J, Preisser F, Chun FKH, Mandel P. Transition from Transrectal to Transperineal MRI-Fusion Prostate Biopsy Does Not Comprise Detection Rates of Clinically Significant Prostate Cancer at a Tertiary Care Center. Diagnostics (Basel) 2024; 14:1184. [PMID: 38893710 PMCID: PMC11171881 DOI: 10.3390/diagnostics14111184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A remarkable paradigm shift has emerged regarding the preferred prostate biopsy approach, favoring the transperineal (TP) over the transrectal (TR) approach due to the reduced risk of severe urinary tract infections. However, its impact on the detection of clinically significant prostate cancer (csPCa) remains unclear. MATERIALS AND METHODS We relied on a prospectively maintained tertiary care database to identify patients who underwent either TP or TR prostate biopsy between 01/2014 and 12/2023. Of those, only patients with suspicious magnetic resonance imaging (MRI) PIRADS lesions (Likert-scale: 3,4,5) received MRI-targeted and systematic biopsies. Detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥ 2) were compared between biopsy approach (TP vs. TR) according to index lesion. Subsequently, uni- and multivariable logistic regression models were applied to investigate the predictive status of the biopsy approach within each subcohort. RESULTS Of 2063 patients, 1118 (54%) underwent combined MRI-guided and systematic prostate biopsy and were included in the final cohort. Of those, 127 (11%) and 991 (89%) underwent TP vs. TR. CsPCa rates, regardless of differences in patients' demographics and distribution of index PIRDAS lesions, did not differ statistically significantly and were 51 vs. 52%, respectively (p = 0.8). CsPCa detection rates for PIRDAS-3, PIRADS-4 and PIRADS-5 did not differ and were 24 vs. 23%, 48 vs. 51% and 72 vs. 76% for PIRADS-3, PIRADS-4 and PIRADS-5 subgroups for TP vs. TR, respectively (all p ≥ 0.9) Conclusions: The current results support the available data indicating that TP biopsy approach is comparable to transrectal biopsy approach regarding csPCa detection rates.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Cristina Cano Garcia
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Carolin Siech
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada
| | - Melissa Schneider
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Carsten Lange
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Miriam Traumann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
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