1
|
Falkenbach F, Budäus L. [Complications after transrectal and transperineal prostate biopsy-results of the first randomized controlled trial: ProBE-PC]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:492-493. [PMID: 38635143 DOI: 10.1007/s00120-024-02343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Fabian Falkenbach
- Martini-Klinik Prostatakarzinomzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Lars Budäus
- Martini-Klinik Prostatakarzinomzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| |
Collapse
|
2
|
Bulusu A, Ferrante S, Wu RC, Qi J, Montie J, Ginsburg KB, Semerjian A, Raman JD, Ginzburg S, Patel A, Rogers CG, George VK, Stork B, George AK. Current Perceptions, Practice Patterns, and Barriers to Adoption of Transperineal Prostate Biopsy under local anesthesia. Urology 2024:S0090-4295(24)00292-9. [PMID: 38679295 DOI: 10.1016/j.urology.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To assess perceptions, practice patterns, and barriers to adoption of Transperineal prostate biopsy (TPBx) under local anesthesia. METHODS Providers from Michigan Urological Surgery Improvement Collaborative (MUSIC) and Pennsylvania Urologic Regional Collaborative (PURC) were administered an online survey to assess beliefs and educational needs regarding TPBx. Providers were divided into those who performed or did not perform TPBx. The MUSIC and PURC registry were queried to assess TPBx utilization. Descriptive analytics and bivariate analysis determined associations between provider/practice demographics and attitudes. RESULTS Since 2019, TPBx adoption has increased more than 2-fold to 7.0% and 16% across MUSIC and PURC practices, respectively. Of 350 urologists invited to participate in a survey, a total of 91 complete responses were obtained with 21 respondents (23%) reported performing TPBx. Participants estimated the learning curve was <10 procedure for TPBx performers and non-performers. No significant association was observed between learning curve and provider age/practice setting. The major perceived benefits of TPBx were decreased risk of sepsis, improved cancer detection rate and antibiotic stewardship. The most commonly cited challenges to implementation included access to equipment and patient experience. Urologists performing TPBx reported learning curve as an additional barrier, while those not performing TPBx reported duration of procedure. CONCLUSIONS Access to equipment and patient experience concerns remain substantial barriers to adoption of TPBx. Dissemination of techniques utilizing existing equipment and optimization of local anesthetic protocols for TPBx may help facilitate the continued adoption of TPBx.
Collapse
Affiliation(s)
- Asha Bulusu
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Stephanie Ferrante
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Richard C Wu
- Department of Urology, E-Da Hospital, Kaoshiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ji Qi
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Jim Montie
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Kevin B Ginsburg
- Department of Urology, Wayne State University, Detroit, Michigan 48201
| | - Alice Semerjian
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; IHA Urology, Ypsilanti, Michigan 48197
| | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, Pennsylvania 17033
| | - Serge Ginzburg
- Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania 19141
| | - Amit Patel
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202
| | | | - Brian Stork
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland 21205.
| |
Collapse
|
3
|
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. [PMID: 38584582 DOI: 10.1111/bju.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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?
Collapse
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
| |
Collapse
|
4
|
Miano R, Manenti G, Orecchia L. TRexit is going one step further. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00819-x. [PMID: 38480974 DOI: 10.1038/s41391-024-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/18/2024]
Affiliation(s)
- Roberto Miano
- Urology Unit, AOU Policlinico Tor Vergata, Rome, Italy.
- Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
| | - Guglielmo Manenti
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, AOU Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Luca Orecchia
- Urology Unit, AOU Policlinico Tor Vergata, Rome, Italy
| |
Collapse
|
5
|
Gatsos S, Kalogeras N, Dimakopoulos G, Samarinas M, Papakonstantinou A, Petinaki E, Tzortzis V, Gravas S. Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study. Prostate Int 2024; 12:35-39. [PMID: 38523904 PMCID: PMC10960084 DOI: 10.1016/j.prnil.2023.11.002] [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] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 03/26/2024] Open
Abstract
Background To evaluate the role of targeted antibiotic prophylaxis (TAP) after rectal and urethral swab cultures compared to empiric antibiotic prophylaxis (EAP) for the prevention of infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Methods We conducted a prospective comparative study on 141 patients who underwent TRUS-Bx and were allocated in two groups. The first group (n = 71) received EAP with ciprofloxacin and the second (n = 70) received TAP according to rectal and urethral cultures. Post-biopsy infectious complications rates were compared between the two groups. Fluoroquinolone resistance (FQ-R) in the urethral and rectal swabs was recorded. Baseline characteristics were analyzed to assess their relationship with infectious complications and antibiotic resistance. Results A total of 8 infectious complications were observed, 7 of them in the EAP group (9.85%) and 1 in the TAP group (1.4%). There was a statistically significant difference in febrile UTIs between the two groups (6 vs 0, P = 0.028). FQ-R rate was 4.3% and 12.9% for rectal and urethral samples, respectively. Recent antibiotic exposure was associated with higher post-biopsy infection rates for EAP group and FQ-R rates for TAP group. Conclusion Combination of rectal and urethral swab cultures for TAP was able to detect FQ-R bacteria carriers and was associated with fewer infectious complications compared to EAP.
Collapse
Affiliation(s)
- Sotirios Gatsos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikolaos Kalogeras
- Department of Urology, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | - Georgios Dimakopoulos
- BIOSTATS, Epirus Science and Technology Park, Campus of the University of Ioannina, Ioannina, Greece
| | | | | | - Efi Petinaki
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | |
Collapse
|
6
|
Ploussard G, Barret E, Fiard G, Lenfant L, Malavaud B, Giannarini G, Almeras C, Aziza R, Renard-Penna R, Descotes JL, Rozet F, Beauval JB, Salin A, Rouprêt M. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsies for Prostate Cancer Diagnosis: Final Results of the Randomized PERFECT trial (CCAFU-PR1). Eur Urol Oncol 2024:S2588-9311(24)00049-X. [PMID: 38403523 DOI: 10.1016/j.euo.2024.01.019] [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: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Recent guidelines favor transperineal (TP) prostate biopsies over the transrectal (TR) approach due to a reduced sepsis risk. Yet, evidence from controlled trial comparing both approaches within the MRI-targeted pathway for significant prostate cancer (PCa) detection is lacking. OBJECTIVE To compare the significant PCa detection rate between magnetic resonance imaging (MRI)-targeted TR and TP approaches in biopsy-naïve patients. DESIGN, SETTING, AND PARTICIPANTS In this noninferiority controlled trial, we randomized (ratio 1:1) 270 MRI-positive biopsy-naïve patients. INTERVENTION MRI-targeted TP versus TR biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES The primary outcome was the detection rate of significant PCa (International Society of Urological Pathology [ISUP] ≥2) in MRI-targeted biopsies. Secondary outcomes were any-grade PCa detection, detection on concomitant systematic biopsy, complications, and functional outcomes. RESULTS AND LIMITATIONS Targeted biopsies identified significant PCa in 47.2% of TP and 54.2% of TR participants (-7%, p = 0.6235). On a per-lesion analysis, posterior lesions yielded higher detection rates via TR (59.0% vs 44.3%, p = 0.0443), while anterior lesions were more frequently detected via TP (40.6% vs 26.5%, p = 0.2228). The overall (any grade) cancer detection rate in targeted biopsies was comparable between groups: 71.3% (TP) versus 64.1% (TR; p = 0.2209) with significantly more ISUP 1 cases detected in the TP arm. Adverse events of grade ≥2 were not different between TP (35.7%) and TR (40.5%, p = 0.4256). One TR patient (0.8%) experienced grade 3 sepsis. Quality of life, and urinary and sexual function, as well as pain scores, were comparable between groups. CONCLUSIONS Despite a comparable overall detection rate for any-grade PCa, noninferiority of TP over TR for MRI-targeted biopsies for significant PCa detection was not demonstrated. However, MRI lesion location influenced biopsy route performance, suggesting that a pragmatic approach based on lesion location might enhance significant PCa assessment. PATIENT SUMMARY This trial compared the efficacy and safety of two biopsy approaches for prostate cancer diagnosis. Both approaches seem complementary according to the lesion location.
Collapse
Affiliation(s)
| | - Eric Barret
- Institut Mutualiste Montsouris, Paris, France
| | - Gaëlle Fiard
- Grenoble Alpes University Hospital, University Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Louis Lenfant
- AP-HP - Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | | | | | - Christophe Almeras
- Clinique Capio La Croix du Sud Cabinet d'Urologie, Quint-Fonsegrives, France
| | - Richard Aziza
- Comprehensive Cancer Cancer IUCT-Oncopole, Toulouse, France
| | | | | | | | | | | | - Morgan Rouprêt
- AP-HP - Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| |
Collapse
|
7
|
Alberti A, Nicoletti R, Polverino P, Rivetti A, Dibilio E, Resta GR, Makrides P, Caneschi C, Cifarelli A, D’Amico A, Moscardi L, Lo Re M, Peschiera F, Gallo ML, Pecoraro A, Sebastianelli A, Masieri L, Gacci M, Serni S, Campi R, Sessa F. Morbidity of Transrectal MRI-Fusion Targeted Prostate Biopsy at a Tertiary Referral Academic Centre: An Audit to Guide the Transition to the Transperineal Approach. Cancers (Basel) 2023; 15:5798. [PMID: 38136344 PMCID: PMC10742076 DOI: 10.3390/cancers15245798] [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: 11/15/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Despite transrectal prostate biopsy (TRPB) being still widespread globally, the EAU Guidelines strongly recommend the transperineal approach, due to the reported lower infectious risk. Our study aims to evaluate the impact of a standardized clinical pathway for TRPB on post-operative complications. We prospectively collected data from all patients undergoing mpMRI-targeted TRPB at our Academic Centre from January 2020 to December 2022. All patients followed a standardized, structured multistep pathway. Post-procedural complications were collected and classified according to the Clavien-Dindo (CD) Classification. Among 458 patients, post-procedural adverse events were reported by 203 (44.3%), of which 161 (35.2%) experienced CD grade 1 complications (hematuria [124, 27.1%], hematochezia [22, 4.8%], hematospermia [14, 3.1%], or a combination [20, 4.4%]), and 45 (9.0%) reported CD grade 2 complications (acute urinary retention or hematuria needing catheterization, as well as urinary tract infections, of which 2 cases required hospitalization). No major complications, including sepsis, were observed. At uni- and multivariable analysis, age > 70 years and BMI > 25 kg/ m2 for patients were identified as predictors of post-operative complications. The results of our study confirm that TRPB is a safe and cost-effective procedure with a low risk of severe adverse events in experienced hands and following a standardized pathway.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, 50134 Florence, Italy; (A.A.); (P.M.); (R.C.)
| |
Collapse
|
8
|
Winters DA, Mehmi A, Odedra A, Wilson L, Ancheta J, Buttleman S, Allchorne P, Rajan P, Khan S, Green JSA. Developing and centralising a nurse-led local anaesthetic transperineal biopsy service during COVID. BJUI COMPASS 2023; 4:715-721. [PMID: 37818022 PMCID: PMC10560612 DOI: 10.1002/bco2.251] [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: 01/25/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Transperineal (TP) biopsy has recently replaced the transrectal ultrasound (TRUS) approach as the ideal method of biopsy in the United Kingdom with growing trends to adopt. To minimise transmission of COVID-19 during the first wave of the pandemic, the British Association of Urological Surgeons Section of Oncology issued guidelines reducing general anaesthesia (GA) procedures and initiate COVID-secure 'green' site diagnostics. As a result of these guidelines and reduction in clinical diagnostics trust-wide, we ceased all TRUS diagnostics and implemented a centralised, nurse-led LA TP biopsy service. Materials and methods A waiting list was developed for those awaiting prostate cancer diagnostics across the network. A COVID-secure 'green' site was quickly identified with TP biopsies starting soon after. Quality improvement methodology was utilised and a run chart was used to show if changes were sustainable. Results Successful implementation and centralisation of a TP biopsy service occurred with TRUS guided biopsies ceasing across all sites on 12 May 2020. The procedures were carried out by urology advanced nurse practitioners under local anaesthesia with a select few occurring under GA. Centralising the service in a COVID-secure manner freed up dedicated theatre sessions and personal leading to increased efficiency elsewhere. The service was robust and was maintained upon lifting of COVID restrictions. Conclusions A centralised, nurse led LA TP biopsy service in a procedural unit was implemented successfully. The service has remained resilient upon lifting of restrictions and return to business as usual. This led to improved performance across trust by freeing up valuable resources and staff to undertake more duties. The service remains highly valued trust-wide.
Collapse
Affiliation(s)
| | - Ashley Mehmi
- Department of UrologyWhipps Cross University Hospital NHS TrustLondonUK
| | - Amar Odedra
- Department of UrologyWhipps Cross University Hospital NHS TrustLondonUK
| | - Lydia Wilson
- Department of UrologyNewham University HospitalLondonUK
| | - Joey Ancheta
- Department of UrologyWhipps Cross University Hospital NHS TrustLondonUK
| | - Sally Buttleman
- Department of UrologyWhipps Cross University Hospital NHS TrustLondonUK
| | - Paula Allchorne
- Department of UrologyWhipps Cross University Hospital NHS TrustLondonUK
| | | | - Shahid Khan
- Department of UrologyNewham University HospitalLondonUK
| | - James S. A. Green
- Department of UrologyWhipps Cross University Hospital NHS TrustLondonUK
| |
Collapse
|
9
|
O' Callaghan ME, Roberts M, Grummet J, Mark S, Gilbourd D, Frydenberg M, Millar J, Papa N. Trends and variation in prostate cancer diagnosis via transperineal biopsy in Australia and New Zealand. Urol Oncol 2023; 41:324.e13-324.e20. [PMID: 37258371 DOI: 10.1016/j.urolonc.2023.05.011] [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: 12/14/2022] [Revised: 04/05/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND To describe changes in the use of prostate biopsy techniques among men diagnosed with prostate cancer in Australia and New Zealand and examine factors associated with these changes. METHODS We extracted data between 2015 and 2019 from 7 jurisdictions of the Australia and New Zealand Prostate Cancer Outcomes Registry (PCOR-ANZ). Distribution and time trend of transrectal (TR) vs. transperineal (TP) biopsy type, differences in the proportion of biopsy type by geographic jurisdiction, diagnosing institute characteristics (public vs. private, metropolitan vs. regional, case volume) and patient characteristics such as socio-economic status (SES), and location of residence were analyzed. RESULTS We analyzed data from 37,638 patients. The overall proportion of prostate cancer diagnosed by TP increased from 26% to 57% between 2015 and 2019. Patients living in a major city, a more socioeconomically advantaged area or who were diagnosed in a metropolitan or private hospital were more likely to have TP than TR. While all subgroups were observed to increase their use of TP over the study period, uptake grew faster for men from low SES areas and those diagnosed at a regional or low-volume hospital but slower for men living in outer regional/remote areas or treated at a public hospital. CONCLUSIONS In this binational registry, prostate cancer is now more commonly diagnosed by TP than the TR approach. While the gap between uptakes of TP has diminished for patients with low vs. high SES, disparity has widened for patients from outer regional areas vs major cities and public vs. private hospitals.
Collapse
Affiliation(s)
- Michael E O' Callaghan
- Urology Unit, Flinders Medical Centre, South Australia, Australia; College of Medicine and Public Health, Flinders University, South Australia, Australia; Discipline of Medicine, University of Adelaide, South Australia, Australia.
| | - Matthew Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, Queensland, Australia
| | - Jeremy Grummet
- Alfred Health, Central Clinical School, Monash University, Victoria, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Stephen Mark
- Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Gilbourd
- Department of Urology, The Canberra Hospital, Australian Capital Territory, Canberra, Australian Capital Territory, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Australian Urology Associates, Melbourne, Australia
| | - Jeremy Millar
- Alfred Health and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| |
Collapse
|
10
|
Bryant RJ, Yamamoto H, Eddy B, Kommu S, Narahari K, Omer A, Leslie T, Catto JWF, Rosario DJ, Good DW, Gray R, Liew MPC, Lopez JF, Campbell T, Reynard JM, Tuck S, Barber VS, Medeghri N, Davies L, Parkes M, Hewitt A, Landeiro F, Wolstenholme J, Macpherson R, Verrill C, Marian IR, Williams R, Hamdy FC, Lamb AD. Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique. BJU Int 2023; 131:694-704. [PMID: 36695816 DOI: 10.1111/bju.15978] [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] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Primary objectives: to determine whether local anaesthetic transperineal prostate (LATP) biopsy improves the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) Grade Group ≥2 disease (i.e., any Gleason pattern 4 disease), compared to transrectal ultrasound-guided (TRUS) prostate biopsy, in biopsy-naïve men undergoing biopsy based on suspicion of csPCa. SECONDARY OBJECTIVES to compare (i) infection rates, (ii) health-related quality of life, (iii) patient-reported procedure tolerability, (iv) patient-reported biopsy-related complications (including bleeding, bruising, pain, loss of erectile function), (v) number of subsequent prostate biopsy procedures required, (vi) cost-effectiveness, (vii) other histological parameters, and (viii) burden and rate of detection of clinically insignificant PCa (ISUP Grade Group 1 disease) in men undergoing these two types of prostate biopsy. PATIENTS AND METHODS The TRANSLATE trial is a UK-wide, multicentre, randomised clinical trial that meets the criteria for level-one evidence in diagnostic test evaluation. TRANSLATE is investigating whether LATP biopsy leads to a higher rate of detection of csPCa compared to TRUS prostate biopsy. Both biopsies are being performed with an average of 12 systematic cores in six sectors (depending on prostate size), plus three to five target cores per multiparametric/bi-parametric magnetic resonance imaging lesion. LATP biopsy is performed using an ultrasound probe-mounted needle-guidance device (either the 'Precision-Point' or BK UA1232 system). TRUS biopsy is performed according to each hospital's standard practice. The study is 90% powered to detect a 10% difference (LATP biopsy hypothesised at 55% detection rate for csPCa vs 45% for TRUS biopsy). A total of 1042 biopsy-naïve men referred with suspected PCa need to be recruited. CONCLUSIONS This trial will provide robust prospective data to determine the diagnostic ability of LATP biopsy vs TRUS biopsy in the primary diagnostic setting.
Collapse
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
| | - Hide Yamamoto
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - Ben Eddy
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Krishna Narahari
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Tom 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
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Daniel W Good
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Rob Gray
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Matthew P C Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - J Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Teresa Campbell
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - John M Reynard
- 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
| | - Nadjat Medeghri
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthew Parkes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Filipa Landeiro
- 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
| | - Ruth 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
| | - 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
| | - 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
| | - 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
| |
Collapse
|
11
|
Kanagarajah A, Hogan D, Yao HH, Dundee P, O'Connell HE. A systematic review on the outcomes of local anaesthetic transperineal prostate biopsy. BJU Int 2023; 131:408-423. [PMID: 36177521 DOI: 10.1111/bju.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature to assess the diagnostic ability, complication rate, patient tolerability, and cost of local anaesthetic (LA) transperineal prostate biopsy. METHODS Two reviewers searched Medline, the Cochrane Library, and Embase for publications on LA transperineal prostate biopsy up to March 2021. Outcomes of interest included cancer detection rates, complication rates, pain assessments and cost. RESULTS A total of 35 publications with 113 944 men were included in this review. The cancer detection rate for LA transperineal prostate biopsy in patients undergoing primary biopsy was 52% (95% confidence interval [CI] 0.45-0.60; I2 = 97) and the clinically significant cancer detection rate (Gleason≥3 + 4) was 37% (95% CI 0.24-0.52; I2 = 99%). The rate of infection-related complications in the included studies was 0.15% (95% CI 0.0000-0.0043; I2 = 86). The LA transperineal procedures had a low rate of procedural abandonment (26/6954, 0.37%), with the greatest pain scores measured during LA administration. No formal cost analyses on LA transperineal prostate biopsies were identified in the literature. The overall risk of bias in the included studies was high, with considerable study heterogeneity and publication bias. CONCLUSION Transperineal prostate biopsy performed under LA is a viable option for centres interested in avoiding the risk of infection associated with transrectal biopsy, and the logistical burden of general anaesthesia. Further investigation into LA transperineal prostate biopsy with comparative studies is warranted for its consideration as the standard in prostate biopsy technique.
Collapse
Affiliation(s)
- Abbie Kanagarajah
- Department of Urology, Western Health, Melbourne, Vic., Australia
- Austin Health, Melbourne, Vic., Australia
| | - Donnacha Hogan
- Department of Urology, Western Health, Melbourne, Vic., Australia
- University College Cork, Cork, Ireland
| | - Henry H Yao
- Department of Urology, Western Health, Melbourne, Vic., Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Philip Dundee
- Department of Urology, Western Health, Melbourne, Vic., Australia
| | | |
Collapse
|
12
|
Pilatz A, Alidjanov J, Bonkat G, Wagenlehner F. [Prostate biopsy-infection prophylaxis and patient preparation]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:459-463. [PMID: 36882551 DOI: 10.1007/s00120-023-02065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
Prostate biopsy has been at the center of controversy in recent years due to high infection complications associated with the transrectal route and the withdrawal of authorization for fluoroquinolones and fosfomycin trometemol as prophylaxis. The Urological Infections Guideline Group of the European Association of Urology (EAU) recently published a meta-analysis in two parts based on randomized controlled trials (RCTs) and annually updates the data for the EAU guidelines. The meta-analyses show that transperineal prostate biopsy is associated with significantly fewer infectious complications than transrectal biopsy and should therefore be preferred. If transrectal biopsy is still used, then intrarectal cleansing with povidone-iodine and antibiotic prophylaxis should be used. Antibiotic prophylaxis strategies include targeted prophylaxis after sensitivity testing of the rectal flora, augmented prophylaxis with several antibiotics and empirical monoprophylaxis. Data from RCTs are available for aminoglycosides and third-generation cephalosporins.
Collapse
Affiliation(s)
- A Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | - J Alidjanov
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | | | - F Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| |
Collapse
|
13
|
Gul ZG, Yu M, Sharbaugh DR, Pekala KR, Lin JY, Sharbaugh AJ, Zhu TS, Worku H, Armann KM, Hudson CN, Hay JM, Grajales V, Yabes JG, Davies BJ, Jacobs BL. Utilizing a Questionnaire to Implement a Risk-Based Antibiotic Prophylaxis Protocol for Transrectal Prostate Biopsy. Urology 2023:S0090-4295(23)00147-4. [PMID: 36868411 DOI: 10.1016/j.urology.2022.11.058] [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: 05/05/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To develop and evaluate a risk-based antibiotic prophylaxis protocol for patients undergoing transrectal prostate biopsy. METHODS We created a risk-based protocol for antibiotic prophylaxis before transrectal prostate biopsy. Patients were screened for infection risk-factors with a self-administered questionnaire. The protocol was implemented from January 1, 2020 to March 31, 2020. We compared patient risk-factors, antibiotic regimens, and 30-day infection rates for patients undergoing transrectal prostate biopsies during the intervention and for a 3-month period before the intervention. RESULTS There were 116 prostate biopsies in the pre-intervention group and 104 in the intervention group. Although there was no significant difference in the number of high-risk patients between the two groups (48% vs 55%; p=0.33), the percentage of patients treated with augmented prophylaxis decreased from 74% to 45% (p=0.03). The duration of antibiotic administration and the median number of doses prescribed also decreased significantly. Despite significant decreases in antibiotic use, there were no differences in infection rates (5% vs 5%; p=0.90) or sepsis rates (1% vs 2%; p=0.60). CONCLUSION We developed a risk-based protocol for prophylactic antibiotics before prostate biopsy. The protocol was associated with less antibiotic use but did not lead to an increase in infectious complications.
Collapse
Affiliation(s)
| | - Michelle Yu
- University of Pittsburgh, Department of Urology
| | | | | | | | | | - Toby S Zhu
- University of Pittsburgh, School of Medicine
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Fletcher P, De Santis M, Ippoliti S, Orecchia L, Charlesworth P, Barrett T, Kastner C. Vector Prostate Biopsy: A Novel Magnetic Resonance Imaging/Ultrasound Image Fusion Transperineal Biopsy Technique Using Electromagnetic Needle Tracking Under Local Anaesthesia. Eur Urol 2023; 83:249-256. [PMID: 36604276 DOI: 10.1016/j.eururo.2022.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prostate magnetic resonance imaging (MRI) is now standard for assessment of suspected prostate cancer (PCa). A variety of approaches to MRI-based targeting has revolutionised prostate biopsies. OBJECTIVE To describe the procedure and show the accuracy and tolerability of a novel Vector MRI/ultrasound fusion transperineal (TP) biopsy technique that uses electromagnetic (EM) needle tracking under local anaesthesia (LA). DESIGN, SETTING, AND PARTICIPANTS Vector prostate biopsy using BiopSee fusion software, EM tracking technology, and transrectal ultrasound was performed in 69 patients meeting the biopsy criteria in two UK centres between September 2020 and August 2022. SURGICAL PROCEDURE Stepper-mounted rectal ultrasound images were fused with MRI scans. LA was applied into two defined perineal tracks and a needle sheath with an EM sensor was inserted. The biopsy needle was directed precisely through the sheath to MRI targets under EM tracking. Biopsies were taken without antibiotic prophylaxis. MEASUREMENTS Cancer detection (any PCa; grade group ≥2), side effects, and patient experience measures were recorded. RESULTS AND LIMITATIONS Cancer detection in patients with Likert 4-5 lesions was 98% for any PCa and 83% for grade group ≥2. According to the 50 questionnaires returned, 42 patients (84%) reported no or minimal pain, while 40 (80%) reported no or minimal discomfort. No episodes of postoperative urinary retention occurred, and only one patient required treatment for infection. Limitations include the low patient number and incomplete responses to questionnaires. CONCLUSIONS This novel Vector technique provides a feasible and tolerable procedure for MRI/ultrasound fusion TP biopsy under LA, with high cancer detection rates. This is achieved while maintaining patient comfort and with minimal rates of complications. PATIENT SUMMARY We report a novel technique that uses electromagnetic needle tracking to perform highly accurate and comfortable prostate biopsies through the perineum under local anaesthetic.
Collapse
Affiliation(s)
| | - Marta De Santis
- International Medical School, Tor Vergata University of Rome, Rome, Italy
| | | | - Luca Orecchia
- Fondazione PTV Policlinico, Tor Vergata University Hospital, Rome, Italy
| | | | - Tristan Barrett
- Cambridge University Hospitals, Cambridge, UK; GenesisCare, Cambridge & Windsor, UK
| | - Christof Kastner
- Cambridge University Hospitals, Cambridge, UK; GenesisCare, Cambridge & Windsor, UK.
| |
Collapse
|
15
|
Berg S, Tully KH, Hoffmann V, Bahlburg H, Roghmann F, Müller G, Noldus J, Reike M. Assessment of complications after transperineal and transrectal prostate biopsy using a risk-stratified pathway identifying patients at risk for post-biopsy infections. Scand J Urol 2023; 57:41-46. [PMID: 36655512 DOI: 10.1080/21681805.2023.2168049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Evidence of transperineal (TP) superiority over transrectal (TR) biopsy is growing due to lower infectious complication rates. However, TR biopsy is the most common procedure, and it seems that a cross-over to TP is delayed by logistical challenges such as costs, complexity, and lack of experience. We investigate whether well-selected patients without any risk factors may further undergo TR biopsy if all precautions to avoid infections are warranted. MATERIALS AND METHODS Data were collected in our academic institution between August 2021 and March 2022 and after clinical implementation of the currently updated European Association of Urology guideline recommendations on the performance of prostate biopsy. Patients underwent either TP or TR biopsy according to a riskstratification based on risk factors of infectious complications. Follow-up asked for post-biopsy complications. Inverse Probability of Treatment Weighting (IPTW) propensity score was used to balance baseline characteristics. Complications were subdivided into infectious and non-infectious complications. RESULTS In total, 294 patients were included with 161 patients undergoing TR vs. 133 patients undergoing TP biopsy. Complication rates were 2.2% for TP vs. 5.5% for TR biopsy concerning all complications. Infectious complication rates only were 0.7% for TP vs. 1.8% for TR biopsy. After IPTW adjustment, differences were statistically significant different (p = 0.01). CONCLUSION Our study revealed that even in a well-selected patient cohort with presumably lower risk of infectious complications, TR biopsy leads to more post-biopsy complications than TP biopsy. This conclusion should motivate the urological community to switch to TP biopsy.
Collapse
Affiliation(s)
- Sebastian Berg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl Heinrich Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Vincent Hoffmann
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Henning Bahlburg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Guido Müller
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.,Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Moritz Reike
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| |
Collapse
|
16
|
Kim EH, Andriole GL. Should men undergo MRI before prostate biopsy - CON. Urol Oncol 2023; 41:92-95. [PMID: 34602360 DOI: 10.1016/j.urolonc.2021.08.006] [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: 05/18/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Prostate magnetic resonance imaging (MRI) is increasingly used prior to biopsy in response to the overdiagnosis and overtreatment of prostate cancer (CaP) associated with prostate-specific antigen (PSA) based screening. However, technical limitations in the conventional diffusion-weighted imaging (DWI) sequences as well as the high degree of radiologist-to-radiologist variability in interpreting prostate MRI result in inadequate accuracy. Specifically, the insufficient negative predictive value (NPV) of prostate MRI (76%-87%) does not allow biopsy to be omitted in the negative MRI setting. Additionally, the variable, and relatively low positive predictive value (PPV) of MRI (27%-44%) provides only an incremental improvement in risk prediction compared to readily available clinical tools such as the Prostate Cancer Prevention Trial risk calculator. This small benefit is likely confined to the minority of patients with positive MRI findings in a typically under-sampled region of the prostate (e.g., anterior lesions), which may be obviated by newer biopsy approaches and tools such as transperineal prostate biopsy and micro-ultrasound technology. With these considerations in mind, pre-biopsy prostate MRI in its current form is unlikely to provide a clinically significant benefit, and should not be considered as routine practice until its accuracy is sufficiently improved.
Collapse
Affiliation(s)
- Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gerald L Andriole
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|
17
|
A Novel Modality Enables New Evidence-Based Individual Risk Stratification That Can Potentially Lead to Decisive Management and Treatment Decisions in Prostate Cancer. Diagnostics (Basel) 2023; 13:diagnostics13030424. [PMID: 36766529 PMCID: PMC9914539 DOI: 10.3390/diagnostics13030424] [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: 12/21/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023] Open
Abstract
A key step in providing management/treatment options to men with suspected prostate cancer (PCa) is categorizing the risk in terms of the presence of benign, low-risk, intermediate-risk, or high-risk disease. Our novel modality brings new evidence, based on the long-known hallmark characteristic of PCa-decreased zinc (Zn), which is the most direct metabolic sign of malignancy and its aggressiveness. To date, this approach has not been adopted for clinical use for a number of reasons that are described in this article, and which have been addressed by our approach. Zn has to be measured on fresh samples, prior to fixating in formalin; therefore, samples have to be scanned during the biopsy session. As Zn depletion occurs in the glands where the tumors develop, estimation of the glands' levels in the scanned tissue, along with their compactness, are essential for accurate diagnosis. Combined with the Zn depletion, this facilitates a reliable assessment of disease aggressiveness. Data gathered in the clinical study described here indicate that, in addition to improving the biopsy quality by real-time interactive guidance, a malignancy score can now be established for the entire prostate, allowing higher granularity personalized risk stratification and more decisive treatment decisions for all PCa patients.
Collapse
|
18
|
Connor MJ, Gorin MA, Eldred-Evans D, Bass EJ, Desai A, Dudderidge T, Winkler M, Ahmed HU. Landmarks in the evolution of prostate biopsy. Nat Rev Urol 2023; 20:241-258. [PMID: 36653670 DOI: 10.1038/s41585-022-00684-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/19/2023]
Abstract
Approaches and techniques used for diagnostic prostate biopsy have undergone considerable evolution over the past few decades: from the original finger-guided techniques to the latest MRI-directed strategies, from aspiration cytology to tissue core sampling, and from transrectal to transperineal approaches. In particular, increased adoption of transperineal biopsy approaches have led to reduced infectious complications and improved antibiotic stewardship. Furthermore, as image fusion has become integral, these novel techniques could be incorporated into prostate biopsy methods in the future, enabling 3D-ultrasonography fusion reconstruction, molecular targeting based on PET imaging and autonomous robotic-assisted biopsy.
Collapse
Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Ankit Desai
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
19
|
Touzani A, Fiard G, Barret E, Renard-Penna R, Salin A, Pradère B, Rozet F, Beauval JB, Malavaud B, Giannarini G, Colin P, Rouprêt M, Ploussard G. Clinical Trial Protocol for PERFECT: A Randomised Controlled Trial Comparing the Efficiency and Tolerance of Transperineal Fusion Versus Transrectal Imaging-targeted Prostate Biopsies (CCAFU-PR1 Study). EUR UROL SUPPL 2022; 45:76-80. [PMID: 36217451 PMCID: PMC9547228 DOI: 10.1016/j.euros.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/18/2022] Open
Abstract
PERFECT is a multicentre randomised controlled clinical trial that evaluates the efficiency of fusion magnetic resonance imaging-targeted biopsies in the transperineal (TP) versus transrectal (TR) approach in terms of the detection of significant cancers. Our study builds on the hypothesis that the TP approach for prostate biopsies has at least the same diagnostic accuracy as the TR approach, with lower morbidity. Here, we describe the clinical protocol, study population, and primary and secondary outcomes.
Collapse
Affiliation(s)
- Alae Touzani
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
- Corresponding author. La Croix du Sud Hospital, 52, Chemin de Ribaute, 31130 Quint Fonsegrives, France. Tel. +33 5 32027202; Fax: +33 5 32027203.
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Baptiste Beauval
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer-Oncopole, Toulouse, France
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia Academic Medical Centre, Udine, Italy
| | - Pierre Colin
- Department of Urology, Clinique La Louvière, Lille, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Guillaume Ploussard
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| |
Collapse
|
20
|
Sigle A, Michaelis J, Schöb D, Benndorf M, Schimmöller L, Becker B, Pallauf M, Gross AJ, Herrmann TRW, Klein JT, Lusuardi L, Netsch C, Häcker A, Westphal J, Jilg C, Gratzke C, Miernik A. [Image-guided biopsy of the prostate gland]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:1137-1148. [PMID: 36040512 DOI: 10.1007/s00120-022-01929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
The recommendations on carrying out a multiparametric magnetic resonance imaging (mpMRI) for the primary diagnostics and during active surveillance of prostate cancer, include as a consequence an image-guided sampling from conspicuous areas. In doing so, the information on the localization provided by mpMRI is used for a targeted biopsy of the area suspected of being a tumor. The targeted sampling is mainly performed under sonographic control and after fusion of MRI and ultrasound but can also be (mostly in special cases) carried out directly in the MRI scanner. In an ultrasound-guided biopsy, it is vital to coregister the MR images with the ultrasound images (segmentation of the contour of the prostate and registration of suspect findings). This coregistration can either be carried out cognitively (transfer by the person performing the biopsy alone) or software based. Each method shows specific advantages and disadvantages in the prioritization between diagnostic accuracy and resource expenditure.
Collapse
Affiliation(s)
- August Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
- Berta-Ottenstein-Programm, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland.
| | - Jakob Michaelis
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Dominik Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Matthias Benndorf
- Medizinische Fakultät, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Lars Schimmöller
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - Maximilian Pallauf
- Johns Hopkins University, Baltimore, USA
- Department für Urologie und Onkologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
- Department für Urologie, Uniklinikum Salzburg, Salzburg, Österreich
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - Thomas R W Herrmann
- Urologie, Spital Thurgau AG, Frauenfeld, Schweiz
- Medizinische Hochschule Hannover, Hannover, Deutschland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Südafrika
| | - Jan-Thorsten Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Lukas Lusuardi
- Paracelsus Medizinische Universitätsklinik für Urologie, Salzburger Landeskliniken, Salzburg, Österreich
| | | | - Axel Häcker
- Klinik für Urologie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Jens Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria-Hilf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Krefeld, Deutschland
| | - Cordula Jilg
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Christian Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Arkadiusz Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| |
Collapse
|
21
|
Bjerklund Johansen TE, Kulchavenya E, Lentz GM, Livermore DM, Nickel JC, Zhanel G, Bonkat G. Fosfomycin Trometamol for the Prevention of Infectious Complications After Prostate Biopsy: A Consensus Statement by an International Multidisciplinary Group. Eur Urol Focus 2022; 8:1483-1492. [PMID: 34920977 DOI: 10.1016/j.euf.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Transrectal ultrasound-guided prostate biopsy (TRPB) has been a standard of care for diagnosing prostate cancer but is associated with a high incidence of infectious complications. OBJECTIVE To achieve an expert consensus on whether fosfomycin trometamol provides adequate prophylaxis in TRPB and discuss its role as prophylaxis in transperineal prostate biopsy (TPPB). EVIDENCE ACQUISITION An international multidisciplinary group of experts convened remotely to discuss how to best use fosfomycin in various clinical settings and patient situations. Six statements related to prostate biopsy and the role of fosfomycin were developed, based on literature searches and relevant clinical experience. EVIDENCE SYNTHESIS Consensus was reached for all six statements. The group of experts was unanimous regarding fosfomycin as a preferred candidate for antimicrobial prophylaxis in TRPB. Fosfomycin potentially also meets the requirements for empiric prophylaxis in TPPB, although further clinical studies are needed to confirm or refute its utility in this setting. There is a risk of bias due to sponsorship by a pharmaceutical company. CONCLUSIONS Antimicrobial prophylaxis is mandatory in TRPB, and fosfomycin trometamol is an appropriate candidate due to low rates of resistance, a good safety profile, sufficient prostate concentrations, and demonstrated efficacy in reducing the risk of infectious complications following TRPB. PATIENT SUMMARY Patients undergoing transrectal ultrasound-guided prostate biopsy (TRPB) have a high risk of infectious complications, and antimicrobial prophylaxis is mandatory. However, increasing antimicrobial resistance, as well as safety concerns with fluoroquinolones, has restricted the number of antimicrobial options. Fosfomycin trometamol meets the requirements for a preferred antimicrobial in the prophylaxis of TRPB.
Collapse
Affiliation(s)
- Truls E Bjerklund Johansen
- Department of Urology, Oslo University Hospital, Nydalen, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark.
| | - Ekaterina Kulchavenya
- Urogenital Department, Novosibirsk Research TB Institute and Novosibirsk Medical University, Novosibirsk, Russian Federation
| | - Gretchen M Lentz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | | | - J Curtis Nickel
- Department of Urology, Queens University, Kingston, ON, Canada
| | - George Zhanel
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Gernot Bonkat
- Department of Urology, alta uro AG, Basel, Switzerland
| |
Collapse
|
22
|
Tzeng M, Basourakos SP, Patel HD, Allaway MJ, Hu JC, Gorin MA. Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System. BJUI COMPASS 2022; 3:434-442. [PMID: 36267202 PMCID: PMC9579885 DOI: 10.1002/bco2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To report the results of a pooled analysis evaluating the cancer detection rates, complications, and tolerability of prostate biopsies performed using the PrecisionPoint Transperineal Access System. Patients and Methods The medical literature was reviewed to identify studies published prior to 1 October 2021 evaluating the PrecisionPoint device for performance of transperineal prostate biopsy. Pooled analyses were performed to assess overall and clinically significant cancer detection rates. Additionally, data on complications as well as patient tolerability of the procedure when performed under local anaesthesia were extracted. Results Transperineal biopsy with the PrecisionPoint Transperineal Access System achieved overall and clinically significant cancer detection rates of 67.9% and 42.6%, respectively. Among patients with Prostate Imaging Reporting and Data System 3, 4, and 5 lesions on prostate magnetic resonance imaging, clinically significant disease was found in 31.7%, 55.7%, and 71.8% of patients, respectively. Complications were rare, with sepsis reported in 4 (0.1%) of 3411 procedures despite frequent omission of antibiotic prophylaxis. Patients reported acceptable tolerability of the procedure when performed under local anaesthesia. Conclusions Within the available medical literature, there is uniform evidence supporting the use of the PrecisionPoint Transperineal Access System for performing prostate biopsy procedures. The reported cancer detection and infectious complication rates with this device are in line with other methods for performing transperineal prostate biopsy. A unique aspect of the PrecisionPoint device is its ability to facilitate performing transperineal prostate biopsy under local anaesthesia. This factor will likely lead to increased adoption of the beneficial transperineal approach to prostate biopsy.
Collapse
Affiliation(s)
- Michael Tzeng
- Department of Urology Weill Cornell Medicine New York New York USA
| | | | - Hiten D. Patel
- Department of Urology Loyola University Medical Center Maywood Illinois USA
| | | | - Jim C. Hu
- Department of Urology Weill Cornell Medicine New York New York USA
| | - Michael A. Gorin
- Urology Associates and UPMC Western Maryland Cumberland Maryland USA
- Department of Urology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| |
Collapse
|
23
|
Ohadian Moghadam S, Nowroozi A, Momeni SA, Nowroozi MR, Heidarzadeh S, Poorabhari A. Antimicrobial resistance profiles for bacteria isolated from rectal swabs in patients candidate for prostate biopsy. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221097557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Infection is one of the common complications of post-prostate biopsy. Therefore, prophylaxis with fluoroquinolones and/or cephalosporins is recommended. We aimed to evaluate the prevalence of antibiotic-resistant bacteria isolated from rectal swabs in candidates for transrectal ultrasound-guided (TRUS) biopsy. The possible patient’s related risk factors attributing to resistance to antibiotics were also assessed. Methods: This cross-sectional study was performed on 126 male patients who were candidates for TRUS biopsy. Rectal swabs were collected and the samples were transferred to the laboratory in Amies transport medium during 2 hours and cultured on MacConkey agar with ciprofloxacin 1 mg/L and ciprofloxacin-resistant strains were identified. Kirby-Bauer disc diffusion method was used to determine the antibiotic susceptibility of the isolates. Results: In total, 59 bacterial isolates were obtained, which were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, respectively, in terms of frequency. They showed the lowest resistance to levofloxacin. Smoking was associated with positive culture results. Age was a factor with a significant effect on carrying ciprofloxacin-resistant strains. Conclusion: Ciprofloxacin resistance was high in almost all strains, but post-biopsy infectious complications were very low. Level of evidence: Not applicable
Collapse
Affiliation(s)
| | - Ali Nowroozi
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Iran
- School of Medicine, Tehran University of Medical Sciences, Iran
| | - Seyed Ali Momeni
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Iran
| | | | - Siamak Heidarzadeh
- Department of Microbiology and Virology, School of Medicine, Zanjan University of Medical Sciences, Iran
| | - Ashkan Poorabhari
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Iran
| |
Collapse
|
24
|
Chiu PKF, Ahmed HU, Rastinehad AR. TRUS Biopsy vs Transperineal Biopsy for Suspicion of Prostate Cancer. Urology 2022; 164:18-20. [PMID: 35181407 DOI: 10.1016/j.urology.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Peter K F Chiu
- S.H. Ho Urology Centre of the Chinese University, Hong Kong, China
| | - Hashim U Ahmed
- Imperial College London, London, England, United Kingdom
| | | |
Collapse
|
25
|
Furrer MA, Hong A, Wetherell D, Heinze SB, Simkin P, Chow K, Lawrentschuk N, Zargar H. Evaluating the diagnostic role of in-bore magnetic resonance imaging guided prostate biopsy: a single-centre study. ANZ J Surg 2022; 92:1486-1491. [PMID: 35482421 PMCID: PMC9324140 DOI: 10.1111/ans.17713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 12/24/2022]
Abstract
Background To evaluate the role of in‐bore MRI‐guided biopsy (IB‐MRGB) in the diagnosis of clinically significant prostate cancer (csPCa). Methods In this tertiary single centre study, a total of 125 consecutive patients receiving IB‐MRGB over a three‐year period were evaluated, including 73 patients who had prior biopsies and 52 biopsy‐naïve patients. We assessed cancer detection rate of patients according to the degree of suspicion based on mpMRI findings. Histopathological data were reviewed by experienced uropathologists. Results The mpMRI was suspicious for PCa (PI‐RADS 4/5) in 77% (96/125) and equivocal (PI‐RADS 3) in 23% (29/125). The detection rate for csPCa was 54.2% (52/96) and 20.7% (6/29) for suspicious lesions (PI‐RADS 4/5) and equivocal lesions (PI‐RADS 3), respectively. In subgroup analysis, patients with previous negative biopsy, overall positive biopsy rate and csPCa detection rate were 48.3% (19/35) and 34.5% (13/35), respectively. In patients on AS, 36/44 (81.8%) and 21/44 (47.8%) had PCa and csPCa respectively. In biopsy‐naïve patients 34/52 (65.4%) and 27/52 (51.92%) had PCa and csPCa respectively. Of the patients on AS, 18/44 (41.6%) upgraded from ISUP 1 to ISUP 2 PCa, and 4/44 (9.1%) upgraded from ISUP 1 to ISUP 3 PCa on IB‐MRGB. A total of 14 Clavien‐Dindo≤2 complications occurred in 14 patients (11.2%) that were directly related to the biopsy. No Clavien‐Dindo≥3 complications occurred. Conclusion MRI‐targeted biopsy is suitable for assessment of csPCa. Given the favourable complications profile, its use may be considered in both the initial biopsy and re‐biopsy settings.
Collapse
Affiliation(s)
- Marc A Furrer
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Hong
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Wetherell
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stefan B Heinze
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul Simkin
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ken Chow
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Homayoun Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Power J, Murphy M, Hutchinson B, Murphy D, McNicholas M, O'Malley K, Murray J, Cronin C. Transperineal ultrasound-guided prostate biopsy: what the radiologist needs to know. Insights Imaging 2022; 13:77. [PMID: 35467261 PMCID: PMC9038983 DOI: 10.1186/s13244-022-01210-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Transperineal ultrasound-guided (TP) prostate biopsy has been shown to significantly decrease the risk of post-procedural sepsis when compared to transrectal ultrasound-guided (TRUS) prostate biopsy. With guidance from the European Urology Association favouring adoption of a TP biopsy route, it is clear that, despite being a more technically challenging procedure, TP biopsy in an outpatient setting will replace TRUS biopsy. This paper gives the reader a succinct summary of outpatient transperineal prostate biopsy under local anaesthetic utilising a free-hand ultrasound technique. Patient preparation and consent process is outlined. A comprehensive pictorial review of the procedure, pitfalls and common post-procedural outcomes is presented. This paper provides a framework and guide for those wishing to adopt the transperineal approach under local anaesthetic.
Collapse
Affiliation(s)
- Jack Power
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland. .,School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Mark Murphy
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - Barry Hutchinson
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - Daragh Murphy
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.,Mater Private Hospital, Dublin, Ireland
| | - Michelle McNicholas
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland.,Mater Private Hospital, Dublin, Ireland
| | - Kiaran O'Malley
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland.,Mater Private Hospital, Dublin, Ireland
| | - John Murray
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland.,Mater Private Hospital, Dublin, Ireland
| | - Carmel Cronin
- Radiology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland.,Mater Private Hospital, Dublin, Ireland
| |
Collapse
|
27
|
Kretschmer A, Kajau H, Margolis E, Tutrone R, Grimm T, Trottmann M, Stief C, Stoll G, Fischer CA, Flinspach C, Albrecht A, Meyer L, Priewasser T, Enderle D, Müller R, Torkler P, Alter J, Skog J, Noerholm M. Validation of a CE-IVD, urine exosomal RNA expression assay for risk assessment of prostate cancer prior to biopsy. Sci Rep 2022; 12:4777. [PMID: 35314720 PMCID: PMC8938406 DOI: 10.1038/s41598-022-08608-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
Improved risk stratification of patients suspected of prostate cancer prior to biopsy continues to be an unmet clinical need. ExoDx Prostate (IntelliScore) “EPI” is a non-invasive urine test utilizing RNA from exosomes to provide a risk score that correlates with the likelihood of finding high grade prostate cancer at biopsy. Here, we present the results from a prospective clinical validation study of EPI-CE, a CE-marked in-vitro diagnostic (IVD) assay, specifically developed for use in European clinical laboratories. The study (NCT04720599) enrolled patients with ≥ 50 years, PSA 2–10 ng/mL, prior to MRI, who were scheduled for initial biopsy. First catch urine samples were collected from participants without prior digital rectal examination or prostate massage. Exosomal RNA was isolated and expression levels of three biomarkers ERG, PCA3 and SPDEF were analyzed according to the EPI-CE Instructions For Use. In the study cohort of N = 109 patients, EPI-CE was validated to have a Negative Predictive Value of 89%, a Sensitivity of 92% and a superior performance to two commonly used multiparametric risk calculators (PCPT and ERSPC) in both Receiver Operating Characteristics with a higher Area Under the Curve for EPI-CE 0.67 (95% CI 0.56–0.77) versus PCPT 0.59 (95% CI 0.47–0.71) and ERSPC 0.60 (95% CI 0.49–0.72) and higher Net Benefits analysis across a wide range of risk acceptance levels. This is the first clinical study reporting on the performance of EPI-CE. We demonstrate that EPI-CE provides information beyond standard clinical parameters and provides a better risk assessment prior to MRI, of patients suspected of prostate cancer, than the commonly used multiparametric risk calculators.
Collapse
|
28
|
Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H. Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible. ANZ J Surg 2022; 92:1480-1485. [PMID: 35274426 PMCID: PMC9314011 DOI: 10.1111/ans.17593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transperineal biopsy (TPB) of the prostate has been increasingly utilized as it has reduced infection risks. Traditionally however, it is performed under general anaesthesia, thus it carries a differing set of risks. Recently, new studies have performed TPB under local anaesthesia with success. In the present study, we explored our experience of performing TPB under local anaesthesia in an Australian cohort. METHODS In this prospective study based at a metropolitan outpatient clinic, patients were provided with TPB under local anaesthesia. We assessed prostate cancer detection rates, complication rates and patient tolerability. Pain tolerability was assess using patient reported pain score on the visual analogue scale. Follow up data was collected at days 7 and 30 post-biopsy via telephone interview. RESULTS A total of 48 patients were enrolled in this study between June 2020 and March 2021. Median age was 65.5 years and median PSA was 6.95 ng/mL. Clinically significant prostate cancer was detected in 58% of patients. During the procedure, pain scores were rated the highest during infiltration of local anaesthetic agent with a median score of 5. By the conclusion of the procedure, median pain score was 1. Vast majority of patients (85.4%) would opt for a repeat TPB under local anaesthesia should the need for prostate biopsy arise again. Two of our patients experienced infectious complications, and one experienced urinary retention. CONCLUSION Our data is in line with currently available data and confirms that TPB under local anaesthesia can be achieved in a safe and tolerable manner.
Collapse
Affiliation(s)
- Anne Hong
- Department of Urology, Austin Hospital, Melbourne, Victoria, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Hemmingway
- Faculty of Business, Law and Arts, Southern Cross University, Lismore, New South Wales, Australia
| | - David Wetherell
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Brendan Dias
- Department of Urology, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Homayoun Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Urology, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
29
|
Apfelbeck M, Clevert DA, Stief CG, Chaloupka M. [Sonography of the prostate : Relevance for urologists in daily clinical routine]. Urologe A 2022; 61:365-373. [PMID: 35244746 DOI: 10.1007/s00120-022-01767-x] [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] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
Despite the continuous technical progress regarding the transrectal ultrasonography of the prostate (TRUS) and its successful use in combination with magnetic resonance imaging (MRI) in MRI-targeted biopsy, there is no radiologic modality being able to rule out clinically significant prostate cancer without the need of systematic biopsy. In the past few years, TRUS regained more attention due to the development of high frequency ultrasound as well as the combination of different ultrasonic modalities like shear wave elastography and contrast-enhanced sonography (CEUS). Currently, multiparametric MRI (mpMRI)-targeted biopsy shows the best results concerning detection rates, sensitivity and specificity of clinically significant prostate cancer compared to systematic biopsy. In the future, transperineal biopsy is probably going to increasingly replace the transrectal biopsy approach. For both approaches, transrectal ultrasonography is necessary to display the prostate and to detect suspicious lesions. Therefore future improvements in transrectal ultrasonography can be expected.
Collapse
Affiliation(s)
- Maria Apfelbeck
- Urologische Klinik und Poliklinik des LMU Klinikums, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie des LMU Klinikums, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Christian G Stief
- Urologische Klinik und Poliklinik des LMU Klinikums, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Michael Chaloupka
- Urologische Klinik und Poliklinik des LMU Klinikums, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| |
Collapse
|
30
|
Basourakos SP, Alshak MN, Lewicki PJ, Cheng E, Tzeng M, DeRosa AP, Allaway MJ, Ross AE, Schaeffer EM, Patel HD, Hu JC, Gorin MA. Role of Prophylactic Antibiotics in Transperineal Prostate Biopsy: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 37:53-63. [PMID: 35243391 PMCID: PMC8883190 DOI: 10.1016/j.euros.2022.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 12/25/2022] Open
Abstract
Context Objective Evidence acquisition Evidence synthesis Conclusions Patient summary
Collapse
|
31
|
Comprehensive analysis of complications after transperineal prostate biopsy without antibiotic prophylaxis: results of a multicenter trial with 30 days' follow-up. Prostate Cancer Prostatic Dis 2022; 25:264-268. [PMID: 34267332 PMCID: PMC9184280 DOI: 10.1038/s41391-021-00423-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND To investigate infectious and non-infectious complications after transperineal prostate biopsy (TPB) without antibiotic prophylaxis in a multicenter cohort. Secondly, to identify whether increasing the number of cores was predictive for the occurrence of complications. Thirdly, to examine the relation between TPB and erectile dysfunction. METHODS We analyzed a retrospective multicenter cohort of 550 patients from three different urological centers undergoing TPB without antibiotic prophylaxis. The median number of cores was 26. Demographic and clinical data were extracted by reviewing patients' electronic medical records and follow-up data such as postoperative complications obtained by structured phone interviews. To investigate the influence of the number of cores taken on the occurrence of complications, we performed univariate and multivariate mixed effects logistic regression models. RESULTS There was no case of sepsis reported. Overall, 6.0% of patients (33/550) presented with any complication besides mild macrohematuria. In all, 46/47 (98%) complications were ≤Grade 2 according to Clavien-Dindo. In multivariate regression analyses, an increased number of cores was associated with overall complications (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02-1.14, P = 0.01) and specifically bleeding complications (OR 1.28, 95% CI 1.11-1.50, P = 0.01) but not with infectious complications (OR 1.03, 95% CI 0.97-1.10, P = 0.67). A total of 14.4% of patients referred impairment of erectile function after TPB. Of note, 98% of these men were diagnosed with prostate cancer. CONCLUSIONS This is the first multicenter trial to investigate complications after TPB without antibiotic prophylaxis. In our study, we found no case of sepsis. This underlines the safety advantage of TPB even without antibiotic prophylaxis and supports the ongoing initiative to abandon TRB of the prostate. A higher number of cores were associated with an increase in overall complications specifically bleeding complications, but not with infectious complications. Post-biopsy erectile dysfunction was mainly present in patients diagnosed with PCa.
Collapse
|
32
|
Schmeusser B, Levin B, Lama D, Sidana A. Hundred years of transperineal prostate biopsy. Ther Adv Urol 2022; 14:17562872221100590. [PMID: 35620643 PMCID: PMC9128053 DOI: 10.1177/17562872221100590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
The earliest recorded efforts to biopsy prostate, in the early 20th century, were made through transperineal (TP) approach, with open perineal prostate biopsy (PBx) being considered the gold standard for prostate cancer (PCa) diagnosis in that era. Later, to minimize morbidity and increase diagnostic accuracy, several technical modifications and transrectal ultrasound (TRUS) assistance were incorporated. However, in the 1980s, the transrectal (TR) approach became the predominant PBx method following the introduction of TRUS-TR PBx with sextant sampling, providing a convenient and efficacious method for prostate sampling. With modernization of PCa diagnosis, a recent resurgence of the TP PBx has been observed, driven primarily by TR drawbacks of infectious complications and sampling limitations. TP PBx is rapidly emerging as the new PBx standard, being officially recommended as the initial approach for biopsy in Europe and is increasingly being conducted and studied in the United States. The modern era of TP PBx is based on the improvements in local anesthesia techniques, TP access systems, and robotic assistance. These modifications and advancements have improved the ease of use, patient comfort, and diagnostic outcomes with TP PBx. Herein, we present a history of the evolution of TP PBx spanning over 100 years and explore the basis of the technique that merits future utilization.
Collapse
Affiliation(s)
- Benjamin Schmeusser
- Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Brandon Levin
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel Lama
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| |
Collapse
|
33
|
Cheng E, Davuluri M, Lewicki PJ, Hu JC, Basourakos SP. Developments in optimizing transperineal prostate biopsy. Curr Opin Urol 2022; 32:85-90. [PMID: 34783715 PMCID: PMC8622440 DOI: 10.1097/mou.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal approach as it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in transperineal prostate biopsy that may optimize the way biopsies are performed in clinical practice. RECENT FINDINGS Similarly, to transrectal biopsy, the transperineal approach also allows for the performance of systematic and MRI-targeted biopsy cores. As transperineal biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to transrectal biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, although transperineal biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for transperineal biopsy scaled nationally will likely result in significant healthcare savings. SUMMARY Transperineal biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional transrectal biopsy. Transperineal biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.
Collapse
Affiliation(s)
- Emily Cheng
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Meenakshi Davuluri
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Patrick J. Lewicki
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Jim C. Hu
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Spyridon P. Basourakos
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| |
Collapse
|
34
|
Pirola GM, Gubbiotti M, Rubilotta E, Castellani D, Trabacchin N, Tafuri A, Princiotta A, Martorana E, Annino F, Antonelli A. Is antibiotic prophylaxis still mandatory for transperineal prostate biopsy? Results of a comparative study. Prostate Int 2021; 10:34-37. [PMID: 35510097 PMCID: PMC9042783 DOI: 10.1016/j.prnil.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/07/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and objectives This study aimed to assess the incidence of urinary tract infections (UTIs) after transperineal prostate biopsy (TP-PB) comparing patients who underwent antibiotic prophylaxis (AP) with patients who had no prophylaxis. Materials and methods This prospective, double-center trial was conducted between August and December 2020. Patient candidates to PB were included with 1:1 allocation to case (Group A-no AP) and control group (Group B-standard AP). All TP-PBs were performed in an outpatient setting under local anesthesia. Data collected 2 weeks after the procedure included incidence of UTIs or bacteriuria, evaluated with a urine culture (UC), main symptoms, and complications related to TP-PBs. Results A total of 200 patients were included (100 patients in each group). The mean age was 66.2 ± 7.7 in Group A and 67.4 ± 8 years in Group B (P = 0.134). Mean prostate volume was 65.5 ± 26.7 vs. 51 ± 24.6 cc (P < 0.001), number of biopsy cores was 17.8 ± 2.4 vs. 14.9 ± 0.8 (P < 0.001), and PSA value was 15.9 ± 28.1 vs. 13.3 ± 22.3 ng/ml (P = 0.017). Overall PCa detection rate was 55% vs. 59% (P = 0.567). Postoperative UTI occurred in one patient in Group A vs. zero in Group B. Asymptomatic bacteriuria was present in 3 vs. 5 patients (P = 0.470) and was not treated with antibiotics. Postoperative hematuria was observed in 13 patients vs. 29 (P < 0.05), and acute urinary retention was observed in one patient in each group. Conclusions The incidence of bacteriuria and UTIs in TP-PBs is not related to AP. Therefore, AP could be discontinued in TP-PB candidates without the risk of increasing UTI-related complications.
Collapse
Affiliation(s)
- Giacomo M. Pirola
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
- Corresponding author. Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy.
| | - Marilena Gubbiotti
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | | | - Daniele Castellani
- Department of Urology, Ospedali Riuniti di Ancona, Le Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | - Filippo Annino
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | | |
Collapse
|
35
|
Rai BP, Mayerhofer C, Somani BK, Kallidonis P, Nagele U, Tokas T. Magnetic Resonance Imaging/Ultrasound Fusion-guided Transperineal Versus Magnetic Resonance Imaging/Ultrasound Fusion-guided Transrectal Prostate Biopsy-A Systematic Review. Eur Urol Oncol 2021; 4:904-913. [PMID: 33478936 DOI: 10.1016/j.euo.2020.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/25/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Magnetic resonance imaging (MRI)-targeted biopsies have changed the dogma in prostate cancer diagnosis. Biopsies can be performed either transrectally (MRI-guided and transrectal ultrasound fusion transrectal biopsy [MRI-TRUSB]) or transperineally (MRI-guided and transrectal ultrasound fusion transperineal biopsy [MRI-TPB]). OBJECTIVE To evaluate the detection and complication rates of MRI-TRUSB and MRI-TPB. EVIDENCE ACQUISITION We performed a literature search in PubMed, Scopus, EMBASE, and CENTRAL, and selected randomized controlled trials (RCTs) and observational studies comparing MRI-TRUSB versus MRI-TPB. EVIDENCE SYNTHESIS Our search identified 3608 studies; we included five in the qualitative and two in the quantitative synthesis. On per-patient pooled analysis for clinically significant prostate cancer (csPCa), MRI-TPB detection rates were significantly higher (relative risk 1.28 [95% confidence interval {CI} 1.03-1.60], p = 0.03). On a per-lesion analysis, MRI-TPB anterior csPCa detection rates were statistically significantly higher (relative risk 2.46 [95% CI 1.22-4.98], p = 0.01). On a per-lesion analysis, MRI-TPB and MRI-TRUSB overall cancer detection rates were 75% and 81.6% (p= 0.53), and csPCa detection rates were 65.7% and 75.5% (p = 0.40), respectively. MRI-TPB had lower complication rates (odds ratio 2.56 [95% CI 1.14-5.56, p < 0.05]). On Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evaluation, we rated all outcomes as "very low" certainty of the evidence for all outcome measures. CONCLUSIONS This review highlights the paucity of good-quality evidence comparing MRI-TPB and MRI-TRUSB. MRI-TPB achieves better detection for csPCa, anterior tumors, and lower infective complications. While RCTs are the highest quality of evidence that can address existing evidence limitations, there are concerns regarding infective complications associated with the MRI-TRUSB. Therefore, the authors propose that researchers and clinicians adopt a pragmatic approach by maintaining prospective databases, internal auditing of the MRI-TPB approach, and comparing these data with historical MRI-TRUSB cohorts. PATIENT SUMMARY We looked at the outcomes by comparing magnetic resonance imaging (MRI)-guided and transrectal ultrasound fusion transrectal biopsy with MRI-guided and transrectal ultrasound fusion transperineal biopsy (TPB). The analysis suggests, based on very low certainty evidence, that MRI-TPB has better detection for clinically significant prostate cancer, anterior tumors, and lower complications.
Collapse
Affiliation(s)
| | - Christoph Mayerhofer
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group.
| |
Collapse
|
36
|
Devetzis K, Kum F, Popert R. Recent Advances in Systematic and Targeted Prostate Biopsies. Res Rep Urol 2021; 13:799-809. [PMID: 34805013 PMCID: PMC8598205 DOI: 10.2147/rru.s291963] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
Collapse
Affiliation(s)
| | - Francesca Kum
- King's College School of Medicine, London, UK.,Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Richard Popert
- Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
| |
Collapse
|
37
|
Chen KW, Pek G, Yufei Q, Toh PC, Kuek N, Lee JKC, Tan LGL, Tsang WC, Chiong E. Comparing outcomes of transperineal to transrectal prostate biopsies performed under local anaesthesia. BJUI COMPASS 2021; 3:197-204. [PMID: 35505694 PMCID: PMC9045583 DOI: 10.1002/bco2.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Objectives Patients and methods Results Conclusion
Collapse
Affiliation(s)
| | - Gregory Pek
- Department of Urology National University Hospital Singapore
| | - Qiao Yufei
- Department of Urology National University Hospital Singapore
| | - Poh Choo Toh
- Department of Urology National University Hospital Singapore
| | - Nicholas Kuek
- Department of Urology National University Hospital Singapore
| | | | | | - Woon Chau Tsang
- Department of Urology National University Hospital Singapore
| | - Edmund Chiong
- Department of Urology National University Hospital Singapore
- Department of Surgery National University of Singapore Singapore
| |
Collapse
|
38
|
Margolis E, Brown G, Partin A, Carter B, McKiernan J, Tutrone R, Torkler P, Fischer C, Tadigotla V, Noerholm M, Donovan MJ, Skog J. Predicting high-grade prostate cancer at initial biopsy: clinical performance of the ExoDx (EPI) Prostate Intelliscore test in three independent prospective studies. Prostate Cancer Prostatic Dis 2021; 25:296-301. [PMID: 34593984 PMCID: PMC9184274 DOI: 10.1038/s41391-021-00456-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/21/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022]
Abstract
Background The ability to discriminate indolent from clinically significant prostate cancer (PC) at the initial biopsy remains a challenge. The ExoDx Prostate (IntelliScore) (EPI) test is a noninvasive liquid biopsy that quantifies three RNA targets in urine exosomes. The EPI test stratifies patients for risk of high-grade prostate cancer (HGPC; ≥ Grade Group 2 [GG] PC) in men ≥ 50 years with equivocal prostate-specific antigen (PSA) (2–10 ng/mL). Here, we present a pooled meta-analysis from three independent prospective-validation studies in men presenting for initial biopsy decision. Methods Pooled data from two prospective multi-site validation studies and the control arm of a clinical utility study were analyzed. Performance was evaluated using the area under the receiver-operating characteristic curve (AUC), negative predictive value (NPV), positive predictive value (PPV), sensitivity, and specificity for discriminating ≥ GG2 from GG1 and benign pathology. Results The combined cohort (n = 1212) of initial-biopsy subjects had a median age of 63 years and median PSA of 5.2 ng/mL. The EPI AUC (0.70) was superior to PSA (0.56), Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) (0.62), and The European Randomized Study of Screening for Prostate Cancer (ERSPC) (0.59), (all p-values <0.001) for discriminating GG2 from GG1 and benign histology. The validated cutoff of 15.6 would avoid 23% of all prostate biopsies and 30% of “unnecessary” (benign or Gleason 6/GG1) biopsies, with an NPV of 90%. Conclusions EPI is a noninvasive, easy-to-use, urine exosome–RNA assay that has been validated across 3 independent prospective multicenter clinical trials with 1212 subjects. The test can discriminate high-grade (≥GG2) from low-grade (GG1) cancer and benign disease. EPI effectively guides the biopsy-decision process independent of PSA and other standard-of-care factors.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mikkel Noerholm
- Exosome Diagnostics, a Bio-techne brand, Martinsried, Germany
| | | | - Johan Skog
- Exosome Diagnostics, a Bio-techne brand, Waltham, MA, USA
| |
Collapse
|
39
|
Hogan D, Kanagarajah A, Yao HH, Wetherell D, Dias B, Dundee P, Chu K, Zargar H, O'Connell HE. Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications. BJUI COMPASS 2021; 2:428-435. [PMID: 35474705 PMCID: PMC8988812 DOI: 10.1002/bco2.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.
Collapse
Affiliation(s)
- Donnacha Hogan
- Department of Urology Western Health Melbourne Victoria Australia
- School of Medicine University College Cork Cork Ireland
| | - Abbie Kanagarajah
- Department of Urology Western Health Melbourne Victoria Australia
- Melbourne Medical School The University of Melbourne Melbourne Victoria Australia
| | - Henry H. Yao
- Department of Urology Western Health Melbourne Victoria Australia
| | - David Wetherell
- Department of Urology Western Health Melbourne Victoria Australia
- Department of Urology Monash Health Melbourne Victoria Australia
| | - Brendan Dias
- Department of Urology Western Health Melbourne Victoria Australia
| | - Phil Dundee
- Department of Urology Western Health Melbourne Victoria Australia
| | - Kevin Chu
- Department of Urology Western Health Melbourne Victoria Australia
- Department of Urology Monash Health Melbourne Victoria Australia
| | - Homayoun Zargar
- Department of Urology Western Health Melbourne Victoria Australia
| | | |
Collapse
|
40
|
Setia S, Smith J, Cendo D, Gorin M, Allaway M, Vourganti S. Outcomes of Freehand Transperineal Prostate Biopsy with Omission of Antibiotic Prophylaxis. BJU Int 2021; 130:54-61. [PMID: 34491606 DOI: 10.1111/bju.15590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the utility of antimicrobial prophylaxis when performing freehand systematic transperineal biopsy. PATIENTS AND METHODS From 1/2012 to 2/2020, freehand transperineal prostate biopsy via angiocatheters or the PrecisionPoint Transperineal Access System was performed on consecutive men with clinical suspicion of prostate cancer or confirmed prostate cancer. Biopsies were performed by a single urologist (developer of the PrecisionPoint system). Clinical data was collected retrospectively. Pre-procedural antibiotics were given to all patients through September 6th, 2016. After this date, antibiotics were omitted from those without risk factors (chronic catherization, concurrent endoscopic procedure, history of sepsis after transrectal (TR) biopsy, history of TR biopsy within the last year, prosthetic joints/heart valves). Patients were assessed one week after biopsy for symptoms, Emergency Department visits, and hospital admissions. Patients who received antimicrobial prophylaxis were compared to those who did not and infectious complications were analyzed. Additionally, oncologic outcomes are reported. RESULTS 988 biopsies (median PSA 7.7 ng/ml) were included in the analysis on 756 men. 538 biopsies (54.4%) received prophylaxis and 450 (48.6%) did not receive prophylaxis. There was a statistical difference in the median age (67 vs 69 years, p < 0.001), abnormal DRE (13% vs 5%, p < 0.001), and history of mpMRI (15% vs 31%, p < 0.001) between the prophylaxis and no prophylaxis cohorts, respectively. There were no documented complications in those who received antibiotics. Within the no prophylaxis cohort, there were three (0.66%) complications (p = 0.09). Two (0.44%) patients had UTIs and one (0.22%) patient experienced post-procedural urinary retention. No patients required hospital admission or ED visit. Clinically significant cancer was detected in 152 (40.0%) and 64 (39.0%) men on initial biopsy and prior negative biopsy, respectively. CONCLUSIONS This data suggests that antimicrobial prophylaxis may be safely omitted in selected patients when utilizing the freehand transperineal approach.
Collapse
Affiliation(s)
| | - John Smith
- Rush University College of Medicine, Chicago
| | | | | | | | | |
Collapse
|
41
|
Rationale and protocol for randomized study of transrectal and transperineal prostate biopsy efficacy and complications (ProBE-PC study). Prostate Cancer Prostatic Dis 2021; 24:688-696. [PMID: 33767354 DOI: 10.1038/s41391-021-00352-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/21/2021] [Accepted: 03/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rrisk of infection and hospitalization after transrectal prostate biopsy (TRBx) has been increasing worldwide. Several modified antibiotic regimens have met with variable success in preventing such infections. Transperineal prostate biopsy (TPBx) is increasingly recommended as the preferred alternative due to a potentially lower risk of post-biopsy infections. Aim of this review is to define the magnitude of post-biopsy complications and the effectiveness of preventive strategies, including TPBx approach. METHODS We performed a focused review of literature on infectious complications after TRBx and detailed the use of various preventive measures. We summarized the effectiveness of several preventive measures, including TPBx, and outlined the inconsistencies in reported outcomes. We identified potential barriers to the uptake of TPBx, including the gap in knowledge such as lack of high-quality evidence. RESULTS Several antibiotic prophylaxis protocols, including targeted and augmented, have been utilized for TRBx without demonstrating a clearly superior regimen. Of the non-antibiotic preventive measure, povidone-iodine rectal prep appears to be most effective strategy. Several single-arm cohort studies have reported very low rates of infections after TPBx and demonstrated the feasibility of an office-based procedure. However, barriers to the adoption of TPBx exist including retrospective data, and conflicting results showing minimal reduction in complications with increased burden of resource utilization. Presently, there are no randomized studies comparing the infectious complications after TRBx and TPBx. We discuss the rationale and protocol for a randomized controlled trial to determine the comparative effectiveness of biopsy techniques. CONCLUSIONS TPBx approach has the potential to lower the rate of post-biopsy infections and hospitalizations. However, there are several barriers to widespread adoption of this approach including inconsistencies in reported outcomes and lack of Level-1 evidence. Randomized controlled studies are required to directly compare the infectious complications associated with each biopsy procedure.
Collapse
|
42
|
Lopez JF, Campbell A, Omer A, Stroman L, Bondad J, Austin T, Reeves T, Phelan C, Leiblich A, Philippou Y, Lovegrove CE, Ranasinha N, Bryant RJ, Leslie T, Hamdy FC, Brewster S, Bell CR, Popert R, Hodgson D, Elsaghir M, Eddy B, Bolomytis S, Persad R, Reddy UD, Foley C, van Rij S, Lam W, Lamb AD. Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis. BJU Int 2021; 128:311-318. [PMID: 33448607 DOI: 10.1111/bju.15337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. PATIENTS AND METHODS Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). RESULTS Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. CONCLUSION Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.
Collapse
Affiliation(s)
| | | | - Altan Omer
- Churchill Hospital Cancer Centre, Oxford, UK
| | | | | | - Tom Austin
- Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - Aaron Leiblich
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yiannis Philippou
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Catherine E Lovegrove
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Nithesh Ranasinha
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tom Leslie
- Churchill Hospital Cancer Centre, Oxford, UK
| | - Freddie C Hamdy
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Ben Eddy
- Kent and Canterbury Hospital, Canterbury, UK
| | | | | | - Utsav D Reddy
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Wayne Lam
- Department of Surgery, University of Hong Kong, Hong Kong SAR, China
| | - Alastair D Lamb
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
43
|
EXIT from TRansrectal prostate biopsies (TREXIT): sepsis rates of transrectal biopsy with rectal swab culture guided antimicrobials versus freehand transperineal biopsy. Prostate Cancer Prostatic Dis 2021; 25:283-287. [PMID: 34413481 DOI: 10.1038/s41391-021-00438-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transrectal prostate biopsy (TRUSBx) holds a risk of prostate biopsy related sepsis. We discuss our step-wise strategies aiming to reduce this risk, including targeted antimicrobials and switching to a freehand transperineal approach (FHTPBx). SUBJECTS AND METHODS This longitudinal cohort study included three groups. Group A underwent TRUSBx with empirical augmented antimicrobial prophylaxis; Group B underwent TRUSBx with targeted antimicrobial prophylaxis, based on rectal-swab cultures/sensitivity; Group C underwent FHTPBx with empirical antimicrobial prophylaxis. Post biopsy sepsis, defined according to the surviving sepsis campaign and confirmed with blood or urinary cultures, were determined and rates between groups were analysed using fisher's exact test. RESULTS Of all 1501 patients, 23 developed post biopsy sepsis; Group A (12/609, 2.0%), B (9/403, 2.2%), C (2/489, 0.4%). Targeted antimicrobials did not reduce the risk of post biopsy sepsis following TRUSBx (A vs B, 2.0% vs 2.2%; p = 0.82). Patients with antimicrobial-resistant rectal flora had an increased post biopsy sepsis rate following TRUSBx despite targeted antimicrobials (9.1% vs 1.1%, p = 0.003). Switching to FHTPBx reduced the risk of developing post biopsy sepsis (A vs C, 2% vs 0.4%, p = 0.03; B vs C, 2.2% vs 0.4%, p = 0.03). CONCLUSIONS Targeted antimicrobials based on rectal swab culture failed to reduce the overall risk of post biopsy sepsis, while FHTPBx nearly eliminated this risk. We recommend the use of transperineal prostate biopsies for all patients as the most effective method to reduce the risk of sepsis.
Collapse
|
44
|
Rothe K, Querbach C, Busch DH, Gschwend JE, Hauner K. [Antibiotic prophylaxis for transrectal prostate biopsy : In the context of restricted indications for fluoroquinolones and antibiotic stewardship]. Urologe A 2021; 61:160-166. [PMID: 34409489 PMCID: PMC8831228 DOI: 10.1007/s00120-021-01618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Die transrektale Prostatastanzbiopsie (TRPB) gehört zu den häufigsten interventionell-urologischen Eingriffen in Deutschland. Es wird leitliniengerecht eine kurzeitige periprozedurale Antibiotikaprophylaxe (PAP) empfohlen. Die Indikationsrücknahme von Fluorchinolonen als PAP-Substanz durch das Bundesinstitut für Arzneimittel und Medizinprodukte macht die Verwendung alternativer Substanzen notwendig. Ziele Im Rahmen der Studie wurde die klinische Praxis der PAP bei TRPB mit Fokus auf infektiöse Komplikationen im Vergleich zwischen Fluorchinolon- und Cotrimoxazol-PAP evaluiert. Methodik Es handelt sich um eine retrospektive monozentrische Auswertung klinischer Routinedaten von Patienten mit TRPB zwischen 03.01.2019 und 28.01.2021. Ergebnisse Es wurden 508 erwachsene männliche Patienten eingeschlossen, das mediane Alter betrug 68 Jahre. 55,9 % erhielten eine Cotrimoxazol-PAP, 40,0 % eine Fluorchinolon-PAP. Insgesamt traten in 5,5 % postinterventionelle Komplikationen auf, davon 50,0 % infektiöse Komplikationen. Der Vergleich von Cotrimoxazol- und Fluorchinolon-PAP ergab keinen Unterschied der Komplikationsraten. Bei aufgrund von Komplikationen durchgeführten mikrobiologischen Urinuntersuchungen zeigten sich Erregernachweise mit Resistenz gegenüber der zuvor eingesetzten PAP im Sinne einer Selektion. Schlussfolgerung Eine Cotrimoxazol-PAP für TRPB ist verglichen mit dem bisherigen Standard einer Fluorchinolon-PAP nicht mit vermehrt infektiösen Komplikationen assoziiert. Die präinterventionelle Analyse von Keimspektrum und Resistenz ermöglicht den Einsatz einer gezielten Prophylaxe und kann somit Komplikationen reduzieren.
Collapse
Affiliation(s)
- Kathrin Rothe
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Technische Universität München Fakultät für Medizin, München, Deutschland
| | - Christiane Querbach
- Krankenhausapotheke Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, München, Deutschland
| | - Dirk H Busch
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Technische Universität München Fakultät für Medizin, München, Deutschland
| | - Jürgen E Gschwend
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Ismaninger Str. 22, 81675, München, Deutschland
| | - Katharina Hauner
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Ismaninger Str. 22, 81675, München, Deutschland.
| |
Collapse
|
45
|
Doan P, Graham P, Lahoud J, Remmers S, Roobol MJ, Kim L, Patel MI. A comparison of prostate cancer prediction models in men undergoing both magnetic resonance imaging and transperineal biopsy: Are the models still relevant? BJU Int 2021; 128 Suppl 3:36-44. [PMID: 34374190 DOI: 10.1111/bju.15554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To externally validate and compare the performance of the European Randomized Study of Screening for Prostate Cancer risk calculator 3/4 (ERSPC-RC3/4), the Prostate Biopsy Collaborative Group risk calculator (PBCG-RC) and the van Leeuwen model to determine which prediction model would perform the best in a contemporary Australian cohort undergoing transperineal (TP) biopsy. MATERIALS AND METHODS A retrospective review identified all patients undergoing TP biopsy across two centres. Of the 797 patients identified, 373 had the data required to test all three risk calculators. The probability of high-grade prostate cancer, defined as International Society of Urological Pathology Grade Group >1, was calculated for each patient. For each prediction model discrimination was assessed using area under the receiver-operating characteristic curve (AUC), calibration using numerical and graphical summaries, and net benefit using decision curve analysis. RESULTS Assessment of model discrimination for detecting high-grade prostate cancer showed AUCs of 0.79 (95% confidence interval [CI] 0.74-0.84) for the ERSPC-RC3/4, 0.81 (95% CI 0.77-0.86) for the van Leeuwen model, and 0.68 (95% CI 0.63-0.74) for the PBCG-RC, compared to 0.58 (95% CI 0.52-0.65) for prostate-specific antigen alone. The ERSPC-RC3/4 was the best calibrated in the moderate-risk range of 10-40%, whilst the van Leeuwen model was the best calibrated in the low-risk range of 0-10%. The van Leeuwen model demonstrated the greatest net benefit from 10% risk onwards, followed closely by the ERSPC-RC3/4 and then the PBCG-RC. CONCLUSION The ERPSC-RC3/4 demonstrated good performance and was comparable to the van Leeuwen model with regard to discrimination, calibration and net benefit for an Australian population undergoing TP prostate biopsy. It is one of the most accessible risk calculators with an easy-to-use online platform, therefore, we recommend that Australian urologists use the ERSPC-RC3/4 to predict risk in the clinical setting.
Collapse
Affiliation(s)
- Paul Doan
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Petra Graham
- Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - John Lahoud
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | | | | | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia.,Specialty of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia.,Specialty of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
46
|
Ippoliti S, Fletcher P, Orecchia L, Miano R, Kastner C, Barrett T. Optimal biopsy approach for detection of clinically significant prostate cancer. THE BRITISH JOURNAL OF RADIOLOGY 2021; 95:20210413. [PMID: 34357796 PMCID: PMC8978235 DOI: 10.1259/bjr.20210413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prostate cancer (PCa) diagnostic and therapeutic work-up has evolved significantly in the last decade, with pre-biopsy multiparametric MRI now widely endorsed within international guidelines. There is potential to move away from the widespread use of systematic biopsy cores and towards an individualised risk-stratified approach. However, the evidence on the optimal biopsy approach remains heterogeneous, and the aim of this review is to highlight the most relevant features following a critical assessment of the literature. The commonest biopsy approaches are via the transperineal (TP) or transrectal (TR) routes. The former is considered more advantageous due to its negligible risk of post-procedural sepsis and reduced need for antimicrobial prophylaxis; the more recent development of local anaesthetic (LA) methods now makes this approach feasible in the clinic. Beyond this, several techniques are available, including cognitive registration, MRI-Ultrasound fusion imaging and direct MRI in-bore guided biopsy. Evidence shows that performing targeted biopsies reduces the number of cores required and can achieve acceptable rates of detection whilst helping to minimise complications and reducing pathologist workloads and costs to health-care facilities. Pre-biopsy MRI has revolutionised the diagnostic pathway for PCa, and optimising the biopsy process is now a focus. Combining MR imaging, TP biopsy and a more widespread use of LA in an outpatient setting seems a reasonable solution to balance health-care costs and benefits, however, local choices are likely to depend on the expertise and experience of clinicians and on the technology available.
Collapse
Affiliation(s)
- Simona Ippoliti
- Urology Department, The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, Norfolk, UK
| | - Peter Fletcher
- Urology Department, Cambridge University Hospitals, Cambridge, UK
| | - Luca Orecchia
- Urology Department, Cambridge University Hospitals, Cambridge, UK.,Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Roberto Miano
- Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy.,Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Christof Kastner
- Urology Department, Cambridge University Hospitals, Cambridge, UK
| | - Tristan Barrett
- Radiology Department, Cambridge University Hospitals, Cambridge, UK
| |
Collapse
|
47
|
Wagenlehner F, Bonkat G, Pilatz A. [Prostate biopsy 2021: current management]. Aktuelle Urol 2021; 52:356-359. [PMID: 33979884 DOI: 10.1055/a-1478-2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infectious complications following prostate biopsy are on the rise due to an increase in antimicrobial resistance, mainly against fluoroquinolones. The use of fluoroquinolones for perioperative prophylaxis is no longer approved by the national authorities in Germany. The EAU guideline group on urological infections has recently published a meta-analysis in two parts based on randomised controlled trials (RCTs). Transperineal prostate biopsy is associated with a significantly reduced rate of infectious complications compared with transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric mono-prophylaxis with non-fluoroquinolones. Data from RCTs are available for aminoglycosides, third-generation cephalosporins and fosfomycin trometamol.
Collapse
Affiliation(s)
- Florian Wagenlehner
- Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen
| | | | - Adrian Pilatz
- Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen
| |
Collapse
|
48
|
Starmer B, Iordan N, McCabe J. Comparing tolerability of local anaesthetic transperineal and transrectal prostate biopsies. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211024075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Local anaesthetic transperineal prostate biopsies have been demonstrated as tolerable. However, to date, the tolerability has not been directly compared to the standard of care for transrectal biopsy. We set out to prospectively compare the tolerability of local anaesthetic transperineal and transrectal prostate biopsies. Patients and methods: All patients between 3 April 2019 to 6 December 2019 undergoing local anaesthetic transperineal / transrectal ultrasound biopsy were prospectively asked to complete a questionnaire using visual analogue scales assessing the tolerability of their biopsy. Results: 108 patients were included. Baseline characteristics (mean): age 66.4 years, prostate-specific antigen 13.7 ng/dl, prostate volume 48 ml. Of the patients 51% had ⩾ Gleason 3+4 prostate cancer. 56 patients had transperineal and 52 patients had transrectal biopsy. Median visual analogue scale scores (0–9: transperineal vs transrectal) for probe insertion, probe presence, local anaesthetic injection and taking biopsy were 3 vs 4 ( p=0.66), 3 vs 3 ( p=0.91), 3 vs 2 ( p=0.15) and 3 vs 3 ( p=0.18), respectively. Median visual analogue scale scores (0–3) for overall pain, embarrassment and how they would describe it to a friend were 1 vs 1 ( p=0.17), 0 vs 0 ( p=0.34) and 1 vs 1 ( p=0.2), respectively (transperineal vs transrectal ultrasound). 42 of the 56 patients in the transperineal group had prior transrectal biopsy. 24/42 patients described local anaesthetic transperineal biopsy as the same or better than transrectal; 15/42 described it as a little worse. Conclusion: Tolerability of local anaesthetic transperineal biopsy is comparable to transrectal biopsy. As such, we advocate the routine use of transperineal biopsy and to phase out the transrectal approach where possible. Level of evidence: 2b
Collapse
Affiliation(s)
| | - Nic Iordan
- St Helen’s and Knowsley Teaching Hospitals, UK
| | - John McCabe
- St Helen’s and Knowsley Teaching Hospitals, UK
| |
Collapse
|
49
|
Briggs LG, Kim M, Gusev A, Rumpf F, Feldman A, McGovern F, Tabatabaei S, Dahl DM. Evaluation of In-Office MRI/US Fusion Transperineal Prostate Biopsy via Free-hand Device during Routine Clinical Practice. Urology 2021; 155:26-32. [PMID: 34048827 DOI: 10.1016/j.urology.2021.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To describe our recent experience with in-office transperineal prostate biopsy, including the adoption of software-assisted MRI/US fusion technology. Technological improvements have recently allowed transperineal biopsy to be effectively integrated into outpatient practices with negligible risk of infection. METHODS We retrospectively reviewed a cohort of men undergoing transperineal prostate biopsy from 2018-2020, at a single institution. We compared this to another cohort of men undergoing transrectal fusion biopsy from 2014-2018, matched to the first cohort based on age, PSA, and presence of prostate cancer diagnosis prior to biopsy. All patients underwent systematic transperineal templated biopsies in addition to fusion biopsies of MRI-visible lesions. Baseline characteristics, MRI findings, biopsy results, and complications were analyzed and compared between the 2 groups. RESULTS One-hundred and thirty men underwent transperineal prostate biopsy, and 130 men underwent transrectal fusion biopsy. Of those who underwent transperineal biopsy, 30% underwent fusion biopsy while all men with the transrectal biopsy underwent fusion biopsy. Men who underwent transperineal vs transrectal biopsy demonstrated lower infection rates (0% vs 0.8%, P = .31) with fewer prophylactic antibiotics prescribed at provider's discretion (48% vs 100%), yet higher total post-biopsy complication rates (6.1% vs 0.8%, P = .036). CONCLUSION Our initial experiences with transperineal prostate biopsy confirm prior findings demonstrating feasibility in outpatient urologic practice without infectious complication. Software-assisted MRI/US fusion technology can be successfully integrated with transperineal biopsies to target suspicious lesions. Higher rates of non-infectious complications were observed compared with transrectal biopsy. Further analysis is needed to determine whether risk profiles improve over the learning curve of this newly implemented approach.
Collapse
Affiliation(s)
| | - Michelle Kim
- Harvard Medical School, Boston, MA; Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Andrew Gusev
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Florian Rumpf
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Adam Feldman
- Harvard Medical School, Boston, MA; Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Francis McGovern
- Harvard Medical School, Boston, MA; Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Shahin Tabatabaei
- Harvard Medical School, Boston, MA; Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Douglas M Dahl
- Harvard Medical School, Boston, MA; Department of Urology, Massachusetts General Hospital, Boston, MA.
| |
Collapse
|
50
|
Sigle A, Jilg CA, Kuru TH, Binder N, Michaelis J, Grabbert M, Schultze-Seemann W, Miernik A, Gratzke C, Benndorf M, Suarez-Ibarrola R. Evaluation of the Ginsburg Scheme: Where Is Significant Prostate Cancer Missed? Cancers (Basel) 2021; 13:cancers13102502. [PMID: 34065418 PMCID: PMC8160743 DOI: 10.3390/cancers13102502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Systematic biopsy according to the Ginsburg scheme is widely used to complement MRI-targeted biopsy for the diagnosis of prostate cancer. This is the first study to evaluate the distribution of cancerous lesions that were missed by the Ginsburg scheme. We found that significant prostate cancer lesions were missed in 3.6% of patients. The majority of the missed lesions (17/39, 43.6%) were localized within the anterior region of the prostate. Complementing the Ginsburg scheme by adding biopsy cores to this region may be considered in certain patients who were extensively pre-biopsied without a conclusive diagnosis or when targeted biopsy was not possible. Moreover, based on Ginsburg scheme sectors and newly defined blind sectors, we developed a new sector map of the prostate that can be applied to focal therapy planning and for the follow-up management of patients under active surveillance. Abstract Background: Systematic biopsy (SB) according to the Ginsburg scheme (GBS) is widely used to complement MRI-targeted biopsy (MR-TB) for optimizing the diagnosis of clinically significant prostate cancer (sPCa). Knowledge of the GBS’s blind sectors where sPCa is missed is crucial to improve biopsy strategies. Methods: We analyzed cancer detection rates in 1084 patients that underwent MR-TB and SB. Cancerous lesions that were missed or underestimated by GBS were re-localized onto a prostate map encompassing Ginsburg sectors and blind-sectors (anterior, central, basodorsal and basoventral). Logistic regression analysis (LRA) and prostatic configuration analysis were applied to identify predictors for missing sPCa with the GBS. Results: GBS missed sPCa in 39 patients (39/1084, 3.6%). In 27 cases (27/39, 69.2%), sPCa was missed within a blind sector, with 17/39 lesions localized in the anterior region (43.6%). Neither LRA nor prostatic configuration analysis identified predictors for missing sPCa with the GBS. Conclusions: This is the first study to analyze the distribution of sPCa missed by the GBS. GBS misses sPCa in few men only, with the majority localized in the anterior region. Adding blind sectors to GBS defined a new sector map of the prostate suited for reporting histopathological biopsy results.
Collapse
Affiliation(s)
- August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Cordula A. Jilg
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | | | - Nadine Binder
- Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, 79110 Freiburg, Germany;
| | - Jakob Michaelis
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Markus Grabbert
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Wolfgang Schultze-Seemann
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Matthias Benndorf
- Department of Radiology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany;
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
- Correspondence: ; Tel.: +49-761-270-25820; Fax: +49-761-270-28960
| |
Collapse
|