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Dryhurst D, Aydin A, Nkwam N. A Transperineal Biopsy of the Prostate Does Not Require Routine Antibiotic Cover. Cureus 2024; 16:e61552. [PMID: 38835558 PMCID: PMC11148703 DOI: 10.7759/cureus.61552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction A transperineal ultrasound-guided prostate biopsy (TPB) under local anaesthetics (LA) after a prostate MRI scan is the gold standard for performing a prostate biopsy in patients with suspected prostate cancer. It has superseded transrectal ultrasound-guided prostate biopsy (TRUSB). Historically, TRUSB by definition was performed in a contaminated environment and was routinely covered with antibiotics to reduce the risks of infection. Despite this, the rate of post-biopsy urosepsis has been documented to be as high as 5% in some series. In the transition from TRUSB to the establishment of a TPB under LA service in our unit, we continued to use a single dose of oral antibiotics for all patients attending for biopsy. The aim of this study is to establish whether the use of single-dose antibiotics has any effect on morbidity rates post-TPB. Methods A retrospective analysis of complications was carried out on 326 consecutive patients, who underwent TPB over a six-month period. One cohort of patients were biopsied with no antibiotic cover (n=149, 45.7%) as compared to another cohort who were given a single dose of oral antibiotics (n=177, 54.3%). Those patients in the group receiving antibiotics received either a single dose of co-amoxiclav or a single dose of ciprofloxacin. Patients with indwelling urethral catheters or with a urinary tract infection (UTI) were excluded from the analyses. All patients were followed- up after a multidisciplinary team meeting discussion (MDT) with either a telephone or a face-to-face consultation. Results A total of 324 (99.4%) patients did not report post-procedural complications. Two patients from the antibiotic group presented with infectious complications (1.1%); one patient was admitted with a prostate abscess and required drainage under general anaesthesia, and another was admitted with urosepsis requiring intravenous antibiotics. In the group who did not receive antibiotics, there were no complications reported, which was not significantly different compared to the antibiotic group (p=0.50). Conclusion Our results demonstrate that the routine use of single-dose antibiotics with TPB does not affect morbidity rates. On the basis of this investigation, we have now stopped using routine antibiotic cover for patients undergoing an LA TPB.
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Affiliation(s)
- David Dryhurst
- Urology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | | | - Nkwam Nkwam
- Urology, King's College Hospital NHS Foundation Trust, London, GBR
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2
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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.
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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.
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Eltafahny A, Alshamlan Y, Almazeedi A, Aldousari S, Salem SM. Transperineal biopsy as a new technique versus well-established transrectal biopsy for diagnosis of prostate cancer - A comparative study. Urol Ann 2024; 16:155-159. [PMID: 38818431 PMCID: PMC11135349 DOI: 10.4103/ua.ua_128_22] [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: 09/24/2022] [Revised: 06/03/2023] [Accepted: 10/11/2023] [Indexed: 06/01/2024] Open
Abstract
Introduction Transrectal (TR) prostate biopsy has been the gold standard for prostate cancer diagnosis for years. With the emergence of transperineal (TP) prostatic biopsy, there is a shift in practice across medical services to adopt TP biopsy as the primary method of prostatic biopsy. Objective The objective of the study is to compare cancer detection rates and complications between TP and TR biopsies in our region providing single-center experience with introduction of TP biopsy. Patients and Methods This is a retrospective study utilizing a prospectively designed database comparing consecutive 80 cases of TP biopsy to 80 cases of TR biopsy in a single center. Results Prebiopsy PSA was 14.2 ± 24.9 ng/dl in the TP group versus 23.7 ± 71.3 ng/dl in the TR group with P = 0.108. Prostate Imaging-Reporting and Data System (PIRAD) 4 and 5 lesions were found in 47 (58.9%) cases of TP biopsy versus 44 (60.3%) of TR group cases and P = 0.131. Cancer was detected in 49 (61.25%) patients in the TP group versus 45 (56.25%) in the TR group with no statistically significant difference and P = 0.665. No cases of hematochezia was reported in TP group, vs 14 (17.5%) reported in TR group with P value <.001. There were no statistically significant differences regarding the incidence of febrile urinary tract infection (UTI), hematuria, and hematospermia in the TP group 0 (0%), 7 (8.75%), and 3 (3.75%) versus 2 (2.50%), 14 (17.50%), and 5 (6.25%) in the TR group with P = 0.497, 0.159, and 0.719 consecutively. Conclusion TP and TR biopsy have comparable cancer detection rates. TP biopsy has a significantly lower rectal bleeding rate than TR biopsy. There is a trend toward lower febrile UTI in the TP group; however, it did not reach statistical significance.
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Affiliation(s)
| | | | | | - Saad Aldousari
- Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait
- Department of Surgery, Urology Division, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Shady Mohamed Salem
- Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait
- Department of Surgery, Urology Division, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- Department of Urology, Menofia University, Shibin El-Kom, Egypt
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Li J, Zhu C, Yang S, Mao Z, Lin S, Huang H, Xu S. Non-Invasive Diagnosis of Prostate Cancer and High-Grade Prostate Cancer Using Multiparametric Ultrasonography and Serological Examination. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:600-609. [PMID: 38238199 DOI: 10.1016/j.ultrasmedbio.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES This study aimed to assess the efficacy of multiparametric ultrasonography (mpUS) combined with serological examination, as a non-invasive method, in detecting prostate cancer (PCa) or high-grade prostate cancer (HGPCa) respectively. METHODS A cohort of 245 individuals with clinically suspected PCa were enrolled. All subjects underwent a comprehensive evaluation, including basic data collection, serological testing, mpUS and prostate biopsy. Random Forest (RF) models were developed, and the mean area under the curve (AUC) in 100 cross-validations was used to assess the performance in distinguishing PCa from HGPCa. RESULTS mpUS features showed significant differences (p < 0.001) between the PCa and non-PCa groups, as well as between the HGPCa and low-grade prostate cancer (LGPCa) groups including prostate-specific antigen density (PSAD), transrectal real-time elastography (TRTE) and intensity difference (ID). The RF model, based on these features, demonstrated an excellent discriminative ability for PCa with a mean area under the curve (AUC) of 0.896. Additionally, another model incorporating free prostate-specific antigen (FPSA) and color Doppler flow imaging (CDFI) achieved a high accuracy in predicting HGPCa with a mean AUC of 0.830. The nomogram derived from these models exhibited excellent individualized prediction of PCa and HGPCa. CONCLUSION The RF models incorporating mpUS and serological variables achieved satisfactory accuracies in predicting PCa and HGPCa.
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Affiliation(s)
- Jia Li
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengwei Zhu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shiping Yang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenshen Mao
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuting Lin
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hang Huang
- Department of Urological, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shihao Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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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.
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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
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Wu RC, Tung MC, Wu CH, Mai HC, Huang WL, Chen SH, Lin VC. A cost-effective transperineal prostate biopsy method utilizes the original transrectal setting. Int Urol Nephrol 2023; 55:2695-2701. [PMID: 37505427 DOI: 10.1007/s11255-023-03705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Transperineal prostate biopsy (TPB) offers an alternative to transrectal prostate biopsy (TRB) for prostate cancer diagnosis. However, TPB may result in additional disposable and capital equipment costs, which can limit implementation within urology practice. Herein, we report the initial experience of a novel TPB technique within a tertiary referral center in Taiwan. MATERIALS AND METHODS A retrospective review of all men undergoing prostate biopsy January to October in 2021 was performed. Both biopsy techniques were performed with the same setting using the convex-convex array ultrasound probe under local anesthesia alone or with the addition of sedation using double free-hand technique. Complications within 30 days and cancer detection rate (CDR) were compared between the groups. RESULTS A total of 118 biopsies were included for final analysis. Eleven patients received systematic biopsy with additional MRI-targeted biopsy (TB) cores with all performed via a transperineal approach. The TPB group (n = 47) and TRB group (n = 58) had similar CDR after excluding TB cores (46.8% vs. 44.8%, p = 0.675). General complication rates for TPB were significantly lower than in the TRB group (27.7% vs. 46.6%, p = 0.047). No patients undergoing TPB had infectious complications, where five episodes were recorded in the TRB group (p = 0.114). CONCLUSIONS TPB performed with convex-convex ultrasound probe and double free-hand technique is safe, feasible, cost-effective, and demonstrates equivalent CDR to TRB. Its use may eliminate infectious hospitalizations while minimizing the need for additional capital in the adoption of TPB.
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Affiliation(s)
- Richard C Wu
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mu-Chaio Tung
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Hsien Wu
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsing-Chia Mai
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Lun Huang
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Sih-Han Chen
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Victor C Lin
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan.
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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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.
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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
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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.
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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
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Alnosayan H, Alharbi MA, Alharbi AH, Aloraini AS, Alfayyadh AM, Almansour M. Initial Outcomes of Freehand Transperineal Biopsies Regarding Diagnostic Value and Safety: An Early Experience at King Fahad Specialist Hospital, Buraydah, Saudi Arabia. Cureus 2023; 15:e39318. [PMID: 37351252 PMCID: PMC10282500 DOI: 10.7759/cureus.39318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prostate cancer is a common type of cancer in Saudi Arabia with a high incidence rate. Trans-rectal ultrasound guided prostatic biopsy (TRUSBx) has been the standard diagnostic study for prostate cancer since a landmark study in 1989 which showed that it is better than digitally directed biopsy sampling of the prostate. As an alternative to TRUSBx, transperineal biopsies (TPBx) have gained popularity as they give a higher accuracy rate and avoid many complications. A new study has been conducted in Riyadh, Saudi Arabia to compare TRUSBx and TPBx showed that TPBx has a significantly higher detection rate of prostate cancer cases compared to TRUSBx (45.1% vs. 29.1%, p=0.003). The aim of this study is to determine the diagnostic value and safety of freehand transperineal prostate biopsy in patients with an elevated prostatic specific antigen (PSA) and/or abnormal digital rectal exam in King Fahad Specialist Hospital KFSH in Buraydah, Qassim region, Saudi Arabia. METHODS This is an observational retrospective study of all patients (n=39) who underwent transperineal biopsies at KFSH to assess the diagnostic value and safety of the procedure. RESULTS The mean age of the patients was 70.3 (SD 10.1) years. The most commonly found diagnosis was adenocarcinoma (61.5%), and incidence of complications was detected in (5.1%) of the patients. CONCLUSION We concluded that the freehand technique TPBx has a high accuracy rate in detecting prostatic cancer. However, the learning curve could be a limiting factor in implementing it. Increasing the number of biopsies could positively affect diagnostic accuracy, especially with our low complication rate in this procedure. A low number of biopsies in the older age group can give an accurate result with a low risk of complications. Although template-guided TPBx and robot-guided TPBx are better options, the freehand technique represents a cost-effective and time-saving alternative. However, more studies are needed to compare the outcome of such a technique.
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Affiliation(s)
- Hatim Alnosayan
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
| | - Mohannad A Alharbi
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
| | - Adel H Alharbi
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
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10
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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.
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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
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11
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Walter M, Trotsenko P, Breit HC, Keller N, Meyer A, Winkel DJ, Seifert HH, Wetterauer C. Safety profile of robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate. Front Oncol 2022; 12:1025355. [DOI: 10.3389/fonc.2022.1025355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
IntroductionRobotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate is a novel and highly accurate procedure. The aim of this study was to evaluate the MonaLisa prostate biopsy system in terms of safety, tolerability, and patient-related outcomes.MethodsThis prospective study included 228 patients, who had undergone Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate at the University Hospital Basel between January 2020 and June 2022. Peri-operative side effects, functional outcomes and patient satisfaction were assessed.ResultsMean pain score on the day of biopsy was 1.3 points on VAS, which remained constant on the day after biopsy. Overall, 32 of 228 patients (14%) developed grade I complications according to Clavien-Dindo classification. No higher-grade complications occurred. Gross haematuria, hematospermia and acute urinary retention occurred in 145/228 (63.6%), 98/228 (43%) and 32/228 (14%) patients, respectively. One patient (0.4%) developed urinary tract infection.ConclusionsRobotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate performed under general anesthesia is a safe and well tolerated procedure. This technique allows to omit perioperative prophylaxis and at the same time minimizes the risk of infectious complications. We attribute the favorable risk profile and tolerability to the minimal invasive approach via two entry points.
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12
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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.
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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
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13
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Görtz M, Nyarangi-Dix JN, Pursche L, Schütz V, Reimold P, Schwab C, Stenzinger A, Sültmann H, Duensing S, Schlemmer HP, Bonekamp D, Hohenfellner M, Radtke JP. Impact of Surgeon's Experience in Rigid versus Elastic MRI/TRUS-Fusion Biopsy to Detect Significant Prostate Cancer Using Targeted and Systematic Cores. Cancers (Basel) 2022; 14:cancers14040886. [PMID: 35205634 PMCID: PMC8870088 DOI: 10.3390/cancers14040886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary For the transfer of suspicious lesions in magnetic resonance imaging (MRI) to ultrasound in prostate fusion biopsy, biopsy platforms can be distinguished by rigid or elastic image registration. This study evaluates the detection rate of these different platforms for transperineal fusion-guided prostate biopsy to detect clinically significant prostate cancer under consideration of the surgeon’s learning curve. In our cohort, rigid and elastic registration systems showed a similar prostate cancer detection rate in experienced surgeons, whereas novices seem to benefit from rigid fusion. In the total cohort, targeted fusion biopsy with a rigid registration system outperformed elastic registration target biopsy with a superior significant prostate cancer detection rate, each compared to systematic saturation biopsy. Thus, rigid target biopsy aided in reducing targeting errors that result in missing MRI-visualized significant prostate cancer. These results can provide valuable decision support in selecting a biopsy fusion platform to increase the detection rate and risk stratification of prostate cancer, especially at the beginning of the surgeon’s learning curve. Abstract Multiparametric magnetic resonance imaging (mpMRI) and MRI/ultrasound fusion-targeted prostate biopsy (FB) have excellent sensitivity in detecting significant prostate cancer (sPC). FB platforms can be distinguished by rigid (RTB) or elastic image registration (ETB). We compared RTB and ETB by analyzing sPC detection rates of both RTB and ETB at different stages of the surgeons’ learning curve. Patients undergoing RTB between 2015–2017 (n = 502) were compared to patients undergoing ETB from 2017–2019 (n = 437). SPC detection rates were compared by Chi-square-test on patient-basis. Combination of transperineal systematic biopsy and each TB served as reference and sub-analyses were performed for different grades of surgeon’s experience. In the RTB subgroup, 233 men (46%) had sPC, compared to 201 (46%) in the ETB subgroup. RTB alone detected 94% of men with sPC and ETB 87% (p = 0.02). However, for at least intermediate-experienced surgeons (>100 FB), no differences occurred between RTB and ETB. In the total cohort, at least intermediate-experienced surgeons detected significantly more sPC (10%, p = 0.008) than novices. Thus, targeted transperineal MRI/TRUS-FB with a RTB registration system showed a similar sPC detection rate to ETB in experienced surgeons but a superior sPC detection rate to ETB in the total cohort. Low-experienced surgeons seem to benefit from RTB.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Helmholtz Young Investigator Group ‘Multiparametric Methods for Early Detection of Prostate Carcinoma’, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: or ; Tel.: +49-62-2156-8820
| | - Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Lars Pursche
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Constantin Schwab
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Albrecht Stenzinger
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany;
| | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, 69120 Heidelberg, Germany;
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
- Department of Urology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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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.
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Carreño D, Gomez A, Torres C, Solano LF. Biopsia de próstata, acceso transperineal bajo anestesia local. Rev Urol 2021. [DOI: 10.1055/s-0041-1740375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Resumen
Objetivo La biopsia de próstata es una ayuda esencial en el diagnóstico de cáncer, siendo el método más utilizado la biopsia transrectal guiada por ultrasonido (TRUS), con una tasa diagnóstica entre el 37% y el 45%, aunque no exenta de complicaciones como infecciones, dolor o sangrado.El enfoque alternativo y seguro a las biopsias TRUS se encuentra en la biopsia transperineal (BTP), realizada comúnmente bajo anestesia regional o general.El objetivo de este estudio fue determinar la efectividad de la BTP bajo anestesia local y guía ultrasonográfica transrectal, con el impacto sobre la sensibilidad del estudio y la tasa de readmisión hospitalaria por infección.
Métodos Estudio de cohorte retrospectiva en el que se evaluaron 83 pacientes sometidos a BTP con anestesia local y guía ultrasonográfica transrectal de enero de 2017 a agosto de 2018 en una ciudad intermedia de Colombia. La muestea incluyó todos los hombres mayores de 18 años con datos de historia clínica disponibles para su análisis, así como los reportes histopatológicos de las biopsias. Se excluyeron casos de rebiopsia o con datos insuficientes.El análisis de datos nominales se realizó mediante la prueba de chi cuadrado, y el de los datos numéricos, con las prubas t de Student o de Mann-Whitney.
Resultados Un total de 83 pacientes, con media de edad de 65 ± 7.9 años fueron sometidos al análisis del estudio histopatológico. Se excluyeron nueve pacientes que no tenían información disponible en el registro clínico sistematizado, ni en historia clínica de formato físico. Se encontró una proporción de positividad y diagnóstico de cáncer de prostata en el 39.7% (33) de los pacientes, distribuidos así: grado de grupo 1 (69.7%; 23); grado de grupo 2 )15.2%; 5); grados de grupos 3 y 4 (3% cada uno de ellos; 2); y grado de grupo 5 (9%; 3). En total, 60% (50) fueron negativos para malignidad y, de estos el 54% (27) tuvo hiperplasia. El antibiótico profiláctico indicado en el 96.7% (80) de los casos fue una cefalosporina de primera generación, administrada en el 15% (12) por vía parenteral preoperatoria. En esta serie de casos, no se documentaron ingresos hospitalarios asociados a infección después del procedimiento.
Conclusiones La biopsia de próstata por vía transperineal es una técnica con rendimiento diagnostico similar al del abordaje transrectal: es segura, rápida, de fácil acceso, con bajo costo y, sobre todo, con un riesgo insignificante de infección y sepsis. Sus beneficios son altamente representativos en un sistema de salud como el de nuestro país, y la BTP facilita el acceso de la población vulnerable del área rural y de ciudades intermedias, en las que no se dispone de un urólogo experto.
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Affiliation(s)
- Dania Carreño
- Facultad de Medicina y Ciencias de la Salud, Universidad Militar Nueva Granada Bogotá, Colombia
| | | | | | - Luis Fernando Solano
- Médico General, Unidad de Cuidados Intensivos Adultos, Fundación Hospital San Carlos
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16
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Wilson ECF, Wreford A, Tamer P, Leonard K, Brechka H, Gnanapragasam VJ. Economic Evaluation of Transperineal versus Transrectal Devices for Local Anaesthetic Prostate Biopsies. PHARMACOECONOMICS - OPEN 2021; 5:737-753. [PMID: 34241824 PMCID: PMC8611168 DOI: 10.1007/s41669-021-00277-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Biopsy of the prostate for suspected cancer is usually performed transrectally under local anaesthesia in the outpatient clinic setting. As this involves piercing the bowel wall, the procedure is associated with a risk of infection. Recently, devices that facilitate transperineal biopsy approaches have been developed that avoid piercing the bowel and so should reduce the risk of infection. OBJECTIVE The aim of this study was to estimate the cost effectiveness of transperineal versus transrectal ultrasound-guided local anaesthesia procedures for prostate biopsy from the perspective of the UK NHS and to estimate the value of further research in the area. METHODS a) Decision tree and Markov model synthesising all relevant evidence estimating the life-time costs and QALYs accrued from each biopsy mode. b) Value of information analysis to predict the return from further research and thus guide future research efforts. RESULTS Transperineal biopsy yields an ICER below £20,000 per QALY gained at a per-procedure device acquisition cost below £81, or £41 for cost-neutrality. These results are driven by differences in consumables cost, reduced cost of treating infections, and QALY gains associated with reduced infections. There is value in future research on the diagnostic accuracy of transperineal versus transrectal biopsies and the incidence of iatrogenic infection and sepsis; consideration should be given to enriching the patient population with men with intermediate-risk disease. CONCLUSIONS Transperineal biopsy devices may be cost effective compared with transrectal biopsy at per-procedure acquisition costs below £81 and cost-neutral if under £41. Future research is required to confirm or refute these findings, particularly randomised comparisons of the diagnostic accuracy and infection risks between the methods.
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Affiliation(s)
- Edward C F Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Alice Wreford
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Priya Tamer
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
| | - Kelly Leonard
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
| | - Hannah Brechka
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
| | - Vincent J Gnanapragasam
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
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17
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He BM, Li RB, Wang HF. Anaesthesia in PROstate Biopsy Pain Obstruction Study: A Study Protocol for a Multicentre Randomised Controlled Study Evaluating the Efficacy of Perineal Nerve Block in Controlling Pain in Patients Undergoing Transperineal Prostate Biopsy. Front Surg 2021; 8:649822. [PMID: 34692757 PMCID: PMC8527031 DOI: 10.3389/fsurg.2021.649822] [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: 07/20/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: Transperineal prostate biopsy is as effective as the transrectal biopsy in detecting prostate cancer and has a lower risk of infection. However, concerning the procedural pain of the transperineal route, a higher level of anaesthesia is needed, which prevents this approach from being widely used. Although several methods of local anaesthesia to relieve pain during transperineal biopsy have been described, few well-designed trials have been conducted to assess the efficacy of local anaesthesia. Methods: This is a prospective, multicentre, randomised controlled study in men suspected of having prostate cancer and planning to undergo transperineal prostate biopsy. The aim of this trial is to determine whether the perineal nerve block and periprostatic block relieve pain to different extents in men undergoing transperineal biopsy. The main inclusion criteria are men aged between 18 and 80 years old, a prostate-specific antigen (PSA) level of 4–20 ng/ml, or/and suspicious rectal examination findings. A sample size of 190 participants, accounting for a 10% loss, is required. All participants will be randomly allocated at a ratio of 1:1 to the perineal nerve block (n = 95) and periprostatic block groups (n = 95). The primary outcome will be the level of the worst pain experienced during the transperineal prostate biopsy procedure, which will be measured by a numerical rating scale (NRS). The key secondary outcomes will include the pain severity score at 1, 6, and 24 h after prostate biopsy. Results: The primary outcome is the level of the worst pain experienced during the prostate biopsy procedure. The main secondary outcomes are as follows: (1) Post-biopsy pain severity score at 1, 6, and 24 h after the prostate biopsy; (2) Changes in blood pressure, heart rate and breathing rate during the biopsy procedure; (3) External manifestations of pain during biopsy; (4) Anaesthesia satisfaction; (5) The detection rate for clinically significant prostate cancer and any prostate cancer. Conclusion: Anaesthesia in PROstate biopsy Pain Obstruction Study (APROPOS) is randomised controlled trial aiming to determine the efficacy of the perineal nerve block in controlling pain in patients undergoing prostate biopsy via the transperineal approach. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04501055.
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Affiliation(s)
- Bi-Ming He
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong-Bing Li
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai-Feng Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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18
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Siyez E. Transrectal povidone-iodine efficiency in reducing infections occurring after transrectal ultrasound guided biopsy of the prostate. Medicine (Baltimore) 2021; 100:e27539. [PMID: 34731153 PMCID: PMC8519225 DOI: 10.1097/md.0000000000027539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The present study aimed to compare infectious complications in men undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx) with and without povidone-iodine transrectal injection using a gavage syringe.The records of 112 patients, who underwent TRUS-Bx between January 2016 and December 2019, were retrospectively reviewed. The biopsy indication was considered high prostate-specific antigen (PSA) level and/or suspicious digital rectal prostate examination findings. Patients' ages, underlying diseases, PSA levels, prostate volumes, pathologic results, and infectious complications after the biopsy were investigated. All the patients received 1500 mg of ciprofloxacin (750 mg twice a day) for 5 days, starting from the day before the procedure. Forty-seven (41.96%) patients received ciprofloxacin prophylaxis with povidone-iodine transrectal injection, while 65 (58.03%) only received ciprofloxacin prophylaxis. All the patients, who were readmitted to the hospital after the procedure, especially with a temperature of higher than 37.8°C, were detected. For the purposes of the study, the priority was placed on the emergence of the rate of febrile infectious complications. Differences in febrile infectious complications in patients, who received ciprofloxacin prophylaxis with transrectal povidone-iodine, and those, who received ciprofloxacin prophylaxis alone before TRUS-Bx, were studied.Febrile infectious complications developed in 10 cases (15.38%) in patients, who received ciprofloxacin antibiotics prophylaxis alone. In the povidone-iodine rectal disinfection group, there was only 1 case of febrile infectious complication (2%). There was no significant difference by clinicopathologic features, age, PSA level, and cancer detection rate between both groups (P > .05). Multivariate logistic regression analysis did not identify any patient subgroups at a significantly higher risk of infection after prostate biopsy. There was no significant side effect associated with povidone iodine.In addition to the use of prophylactic antibiotics, transrectal povidone-iodine was useful in reducing the febrile infection complications following TRUS-Bx.
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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
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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
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20
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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.
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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
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21
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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.
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Affiliation(s)
| | - John Smith
- Rush University College of Medicine, Chicago
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22
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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.
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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
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23
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Islam M, Da Silva RD, Quach A, Gustafson D, Nogueira L, Clark N, Kim FJ. Are outpatient transperineal prostate biopsies without antibiotic prophylaxis equivalent to standard transrectal biopsies for patient safety and cancer detection rates?A retrospective cohort study in 222 patients. Patient Saf Surg 2021; 15:28. [PMID: 34419137 PMCID: PMC8380346 DOI: 10.1186/s13037-021-00303-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe our experience with outpatient transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. METHODS In our retrospective review, we compared the TPB to TRB in our institution for outpatient prostate biopsies with local anesthesia from June 1st, 2017 to June 1st, 2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. RESULTS Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. CONCLUSION Outpatient TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.
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Affiliation(s)
- Majdee Islam
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA
| | - Rodrigo Donalisio Da Silva
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA.
| | - Alan Quach
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA
| | - Diedra Gustafson
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA
| | - Leticia Nogueira
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA
| | - Nathan Clark
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA
| | - Fernando J Kim
- Department of Surgery / Division of Urology, Denver Health Medical Center, 777 Bannock St, Denver, Pavilion A, 3RD Floor, Surgery Administration, Denver, CO, 80204, USA
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24
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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.
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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
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25
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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.
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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
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26
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El-Achkar A, Al-Mousawy M, Abou Heidar N, Moukaddem H, Hussein H, Mouallem N, El-Hajj A, Bulbul M. Magnetic resonance imaging /ultrasonography fusion transperineal prostate biopsy for prostate cancer: Initial experience at a Middle Eastern tertiary medical centre. Arab J Urol 2021; 19:454-459. [PMID: 34881061 PMCID: PMC8648043 DOI: 10.1080/2090598x.2021.1926727] [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: 12/15/2020] [Accepted: 02/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To report on the outcomes of magnetic resonance imaging (MRI)/ultrasonography (US)-fusion transperineal prostate (TP) biopsy at a tertiary medical centre in the Middle East including detection rate of clinically significant prostate cancer (csPCa), complications, and tolerability of the procedure. Patients and methods: Between May 2019 and June 2020, 98 MRI/US-fusion TP biopsies were performed in the US suite using light sedation. All patients had pre-biopsy 3-T multiparametric MRI. Data on patient characteristics, PCa detection rate and complication rates were collected retrospectively. A Gleason score ≥3 + 4 was defined as csPCa. RESULTS There were 98 patients, with a mean (SD) age of 65 (9.1) years, and a median (SD) prostate-specific antigen level prior to biopsy of 7.53 (12.97) ng/mL and prostate volume of 51 (31.1) mL. PCa was detected in 54 (55%) patients, with csPCa detected in 43 (44%). A total of 124 Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 lesions were targeted. Grade Group ≥2 PCa was found in 35.5% of the targeted lesions. Random biopsies detected one csPCa Gleason score 3 + 4 in one patient with a negative target. None of the patients had post-biopsy haematuria or retention. Only one patient developed acute prostatitis requiring in-patient intravenous antibiotics. CONCLUSIONS MRI/US-fusion TP biopsy has an adequate detection rate of csPCa with minimal complications and low infection rates after biopsy. This is one of the first TP biopsy series in the Middle East paving the way for wider adoption in the region. ABBREVIATIONS AS: active surveillance; AUR: acute urinary retention; GG: Grade Group; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; TP: transperineal; US: ultrasonography; TRUS: transrectal Ultrasound guided.
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Affiliation(s)
- Adnan El-Achkar
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Mouhammad Al-Mousawy
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Nassib Abou Heidar
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Hisham Moukaddem
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Hero Hussein
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Nadim Mouallem
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Albert El-Hajj
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Muhammad Bulbul
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
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27
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Knull E, Bax JS, Park CKS, Tessier D, Fenster A. Design and validation of an MRI-compatible mechatronic system for needle delivery to localized prostate cancer. Med Phys 2021; 48:5283-5299. [PMID: 34131933 DOI: 10.1002/mp.15050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Prostate cancer is the most common non-cutaneous cancer among men in the United States and is the second leading cause of cancer death in American men. (Siegel et al. [2019] CA: A Cancer J Clin.69(1):7-34.) Focal laser ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. The purpose of this work was to design and evaluate the accuracy of an MR-compatible mechatronic system for in-bore transperineal guidance of FLA ablation needles to localized lesions in the prostate. METHODS The mechatronic system was constructed entirely of non-ferromagnetic materials, with actuation controlled by piezoelectric motors and optical encoders. The needle guide hangs between independent front and rear two-link arms, which allows for horizontal and vertical translation as well as pitch and yaw rotation of the guide with a 6.0 cm range of motion in each direction. Needles are inserted manually through a chosen hole in the guide, which has been aligned with the target in the prostate. Open-air positioning error was evaluated using an optical tracking system (0.25 mm RMS accuracy) to measure 125 trajectories in free space. Correction of systematic bias in the system was performed using 85 of the trajectories, and the remaining 40 were used to estimate the residual error. The error was calculated as the horizontal and vertical displacement between the axis of the desired and measured trajectories at a typical needle insertion depth of 10 cm. MR-compatibility was evaluated using a grid phantom to assess image degradation due to the presence of the system, and induced force, heating, and electrical interference in the system were assessed qualitatively. In-bore positioning error was evaluated on 25 trajectories. RESULTS Open-air mean positioning error at the needle tip was 0.80 ± 0.36 mm with a one-sided 95% confidence interval of 1.40 mm. The mean deviation of needle trajectories from the planned direction was 0.14 ± 0.06∘ . In the MR bore, the mean positioning error at the needle tip was 2.11 ± 1.05 mm with a one-sided 95% prediction interval of 3.84 mm. The mean angular error was 0.49 ± 0.26∘ . The system was found to be compatible with the MR environment under the specified gradient-echo sequence parameters used in this study. CONCLUSION A complete system for delivering needles to localized prostate tumors was developed and described in this work, and its compatibility with the MR environment was demonstrated. In-bore MRI positioning error was sufficiently small for targeting small localized prostate tumors.
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Affiliation(s)
- Eric Knull
- School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jeffrey Scott Bax
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Claire Keun Sun Park
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David Tessier
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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28
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Günzel K, Magheli A, Baco E, Cash H, Heinrich S, Neubert H, Schlegel J, Schostak M, Henkel T, Asbach P, Hinz S. Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis. World J Urol 2021; 39:3861-3866. [PMID: 33866401 DOI: 10.1007/s00345-021-03699-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to assess the post biopsy infection rate, feasibility and prostate cancer (PCa) detection rate (CDR) by performing transperineal MRI-TRUS fusion biopsy of the prostate (TPBx) under local anesthesia (LA) without antibiotic prophylaxis (AP). METHODS We prospectively screened 766 men with suspicious lesions on mpMRI, an elevated PSA level or a suspect digital examination undergoing MRI-TRUS-TPBx in LA, from May 2019 to July 2020. Patients with the need for antibiotic prophylaxis or without a PI-RADS target lesion were excluded from final analyses. We reported CDR, perioperative pain (0-10) and postoperative complications. PCa with an ISUP grade ≥ 2 was classified as clinically significant PCa (csPCa). RESULTS We included 621 patients with a median age of 68 years (IQR 62-74), a PSA of 6.43 ng/mL (IQR 4.72-9.91) and a prostate volume of 45 cc (IQR 32-64). In median, 4 targeted (TB) (IQR 3-4) and 6 (IQR 5-7) systematic biopsies (SB) detected in combination overall 416 (67%) PCa and 324 (52%) csPCa. Overall CDR of TB for PI-RADS 3, 4 and 5 was 26%, 65% and 84%, respectively. Patients reported a median perioperative pain level of 2 (IQR 1-3). Four patients (0.6%) developed a post biopsy infection, one experienced urosepsis. CONCLUSION Our results demonstrate that transperineal MRI-TRUS fusion-guided prostate biopsy under LA without AP is feasible, safe and well tolerated.
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Affiliation(s)
- K Günzel
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany.
| | - A Magheli
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - E Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - H Cash
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - S Heinrich
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - H Neubert
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - J Schlegel
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - M Schostak
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - T Henkel
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - P Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Hinz
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
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29
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Nomura S, Toyama Y, Akatsuka J, Endo Y, Kimata R, Suzuki Y, Hamasaki T, Kimura G, Kondo Y. Prostatic abscess with infected aneurysms and spondylodiscitis after transrectal ultrasound-guided prostate biopsy: a case report and literature review. BMC Urol 2021; 21:11. [PMID: 33478455 PMCID: PMC7818722 DOI: 10.1186/s12894-021-00780-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Transrectal ultrasonography (TRUS)-guided prostate biopsy is the conventional method of diagnosing prostate cancer. TRUS-guided prostate biopsy can occasionally be associated with severe complications. Here, we report the first case of a prostate abscess with aneurysms and spondylodiscitis as a complication of TRUS-guided prostate biopsy, and we review the relevant literature. Case presentation A 78-year-old man presented with back pain, sepsis, and prostate abscesses. Twenty days after TRUS-guided prostate biopsy, he was found to have a 20-mm diameter abdominal aortic aneurysm that expanded to 28.2 mm in the space of a week, despite antibiotic therapy. Therefore, he underwent transurethral resection of the prostate to control prostatic abscesses. Although his aneurysm decreased to 23 mm in size after surgery, he continued to experience back pain. He was diagnosed as having pyogenic spondylitis and this was managed using a lumbar corset. Sixty-four days after the prostate biopsy, the aneurysm had re-expanded to 30 mm; therefore, we performed endovascular aneurysm repair (EVAR) using a microcore stent graft 82 days after the biopsy. Four days after the EVAR, the patient developed acute cholecystitis, and he underwent endoscopic retrograde biliary drainage. One hundred and sixty days after the prostate biopsy, all the complications had improved, and he was discharged. A literature review identified a further six cases of spondylodiscitis that had occurred after transrectal ultrasound-guided prostate biopsy. Conclusions We have reported the first case of a complication of TRUS-guided prostate biopsy that involved prostatic abscesses, aneurysms, and spondylodiscitis. Although such complications are uncommon, clinicians should be aware of the potential for such severe complications of this procedure to develop.
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Affiliation(s)
- Shunichiro Nomura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yuka Toyama
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryoji Kimata
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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30
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Tan JL, Papa N, Hanegbi U, Snow R, Grummet J, Mann S, Cuthbertson A, Frydenberg M, Moon D. Predictors of erectile dysfunction after transperineal template prostate biopsy. Investig Clin Urol 2021; 62:159-165. [PMID: 33660442 PMCID: PMC7940858 DOI: 10.4111/icu.20200236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To investigate the incidence and possible contributing factors of erectile dysfunction (ED) after transperineal template prostate biopsy (TTPB). Materials and Methods Males undergoing TTPB were prospectively administered a Sexual Health Inventory for Men (SHIM) questionnaire before biopsy and one month after. SHIM questionnaires were repeated at 3- and 9-months for males not receiving interventional treatment. Sexually inactive males were excluded. Interval change in SHIM categories based upon baseline characteristics were evaluated. Multivariable logistic regression models were used to evaluate predictors of change in SHIM score category. Results A total of 576 males were included in our sample. Of these, 450 (78%) males underwent their first biopsy. A decline in SHIM category within the immediate 4-weeks post-biopsy was reported by 167 males (31% of total eligible sample). Age was the strongest predictor of decline in SHIM category, the predicted probability of a decline in SHIM at age 50 was 10% (95% confidence interval [CI], 1%–19%), 32% at age 60 (95% CI, 25%–40%) and 36% at age 70 (95% CI, 29%–44%). For new onset ED, the predicted probability of ED within 4-weeks post-TTPB were 6.7% at age 50 (95% CI, 0%–15%), 26% at age 60 (95% CI, 17%–34%) and 31% at age 70 (95% CI, 21%–40%). Conclusions Older age at biopsy is an independent predictor of immediate ED after TTPB in sexually active males. This association was observed in the subgroup with no pre-existing ED. These findings provide useful information when counselling males undergoing TTPB.
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Affiliation(s)
- Jo Lynn Tan
- Department of Urology, St. Vincent's Hospital Melbourne, Victoria, Australia.
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Uri Hanegbi
- Australian Urology Associates, Malvern, Victoria, Australia
| | - Ross Snow
- Australian Urology Associates, Malvern, Victoria, Australia
| | - Jeremy Grummet
- Australian Urology Associates, Malvern, Victoria, Australia.,Department of Urology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah Mann
- Department of Urology, Epworth Healthcare, Melbourne, Victoria, Australia
| | | | - Mark Frydenberg
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Australian Urology Associates, Malvern, Victoria, Australia.,Department of Urology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Daniel Moon
- Australian Urology Associates, Malvern, Victoria, Australia.,Department of Urology, Epworth Healthcare, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
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31
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Thomson A, Li M, Grummet J, Sengupta S. Transperineal prostate biopsy: a review of technique. Transl Androl Urol 2020; 9:3009-3017. [PMID: 33457274 PMCID: PMC7807331 DOI: 10.21037/tau.2019.12.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
As the second most diagnosed cancer worldwide, prostate cancer is confirmed via tissue biopsy. Given the large number of prostate biopsies performed each year, the technique should be as accurate and safe as possible for the patient’s well-being. Transrectal ultrasound guided prostate biopsy (TRUS-biopsy) is most offered worldwide. Transperineal biopsy (TPP-biopsy), on the other hand, has been gaining popularity due to its superior sensitivity and lower rate of sepsis. This article offers a review of the brachytherapy grid technique used to perform a TPP-biopsy, as well as a discussion of possible variations in the procedure. TPP-biopsy is typically performed under general anaesthesia with patient in lithotomy. Through the perineum, cores of tissue are taken systematically, with or without targeting, under US guidance. Different fusion techniques (cognition, MRI-US fusion software, MRI in-bore) can be used to target pre-identified lesions on MRI. The sampling can be done either by free hand or using a brachytherapy grid. Robotic assisted prostate biopsy is also available on the market as an alternative. In recent years, there has been accumulating evidence showing that it is safe and feasible to perform TPPB under local anaesthesia. This may improve the uptake of TPPB as the preferred biopsy technique for prostate cancer.
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Affiliation(s)
- Alice Thomson
- Urology Department, Eastern Health, Box Hill, Victoria, Australia
| | - Mo Li
- Urology Department, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Jeremy Grummet
- Urology Department, Alfred Hospital, Prahran, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Shomik Sengupta
- Urology Department, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Department of Surgery, University of Melbourne, Heidelberg, Victoria, Australia
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32
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Ortner G, Tzanaki E, Rai BP, Nagele U, Tokas T. Transperineal prostate biopsy: The modern gold standard to prostate cancer diagnosis. Turk J Urol 2020; 47:S19-S26. [PMID: 33052837 DOI: 10.5152/tud.2020.20358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
In patients suspicious for prostate cancer, a prostate biopsy should be performed. Biopsies are possible either by the transrectal or transperineal routes. Compared with the transrectal prostate biopsy (TRPBx), transperineal prostate biopsy (TPPBx) offers a non-inferior cancer detection rate (CDR), especially in patients undergoing re-biopsy for persistently elevated PSA and in cases of active surveillance (AS), in which TPPBx seems to be superior. Moreover, the transperineal route achieves superior sampling of the anterior and apical regions, especially after previous multiple negative TRPBx. Infectious complications are nullified due to avoidance of needle passage through the rectal mucosa, and there is a highly significant evidence of reduced fever and sepsis rates when compared with TRPBx, with maintaining acceptable urinary retention rates. This is an important upcoming topic due to the increasing antibiotic resistance rates, thus reducing periinterventional hospitalization and health care costs. To date, TPPBx is perfectly feasible in the inpatient and out-patient settings and under local anesthesia, characterized by a moderate learning curve and a good reproducibility. By applying mpMRI as a diagnostic tool, clinically significant prostate cancer (csPCa) detection seems to be comparable to transrectal MRI-fusion biopsy (TR-MRIFBx). Finally, focal treatment of localized disease is currently performed exclusively through a TP approach.
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Affiliation(s)
- Gernot Ortner
- 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
| | - Eirini Tzanaki
- University of Pavia, Medical School, Harvey Course, Pavia, Italy
| | | | - 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
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33
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Ong XRS, Bagguley D, Yaxley JW, Azad AA, Murphy DG, Lawrentschuk N. Understanding the diagnosis of prostate cancer. Med J Aust 2020; 213:424-429. [PMID: 33047355 DOI: 10.5694/mja2.50820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prostate cancer continues to be the most commonly diagnosed cancer, and the second leading cause of cancer death among Australian men. Prostate-specific antigen testing is personalised (not dichotomous in nature) and its interpretation should take into account the patient's age, symptoms, previous results and medication (eg, 5-α reductase inhibitors such as dutasteride). Multiparametric magnetic resonance imaging of the prostate has been proven to have a 93% sensitivity for detecting clinically significant prostate cancer. It has the potential to decrease unnecessary prostate biopsies by around 27%. International Society of Urological Pathology (ISUP) grade 1 (Gleason score 6) has been shown to have very little, if any, risk of metastasis ISUP grade 1 (Gleason score 3 +3 = 6) and low percentage ISUP grade 2 (Gleason score 3 + 4 [< 10%] = 7) can be offered active surveillance. The goal of active surveillance is to defer treatment but is still curative when required. With better imaging (magnetic resonance imaging and emerging prostate-specific membrane antigen positron emission tomography-computed tomography) and transperineal prostate biopsy, more men can be offered screening after discussion of risks and benefits, knowing that overdiagnosis has been minimised and radical treatment is reserved for only the most aggressive disease.
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Affiliation(s)
- Xuan Rui S Ong
- EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Dominic Bagguley
- EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - John W Yaxley
- University of Queensland, Brisbane, QLD.,Royal Brisbane and Women's Hospital, Brisbane, QLD
| | - Arun A Azad
- University of Melbourne, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
| | - Declan G Murphy
- University of Melbourne, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
| | - Nathan Lawrentschuk
- EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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34
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Jiang CY, Shen PF, Wang C, Gui HJ, Ruan Y, Zeng H, Xia SJ, Wei Q, Zhao FJ. Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study. Asian J Androl 2020; 21:612-617. [PMID: 31006712 PMCID: PMC6859663 DOI: 10.4103/aja.aja_16_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study compared the diagnostic efficacy of transrectal ultrasound (TRUS)-guided prostate biopsy (TRBx) and transperineal prostate biopsy (TPBx) in patients with suspected prostate cancer (PCa). We enrolled 2962 men who underwent transrectal (n = 1216) or transperineal (n = 1746) systematic 12-core prostate biopsy. Clinical data including age, prostate-specific antigen (PSA) level, and prostate volume (PV) were recorded. To minimize confounding, we performed propensity score-matching analysis. We measured and compared PCa detection rates between TRBx and TPBx, which were stratified by clinical characteristics and Gleason scores. The effects of clinical characteristics on PCa detection rate were assessed by logistic regression. For all patients, TPBx detected a higher proportion of clinically significant PCa (P < 0.001). Logistic regression analyses illustrated that PV had a smaller impact on PCa detection rate of TPBx compared with TRBx. Propensity score-matching analysis showed that the detection rates in TRBx were higher than those in TPBx for patients aged >- 80 years (80.4% vs 56.5%, P = 0.004) and with PSA level 20.1-100.0 ng ml-1 (80.8% vs 69.1%, P = 0.040). In conclusion, TPBx was associated with a higher detection rate of clinically significant PCa than TRBx was; however, because of the high detection rate at certain ages and PSA levels, biopsy approaches should be optimized according to patents' clinical characteristics.
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Affiliation(s)
- Chen-Yi Jiang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Peng-Fei Shen
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Cheng Wang
- Department of Urology, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, China
| | - Hao-Jun Gui
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Yuan Ruan
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Shu-Jie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China
| | - Fu-Jun Zhao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.,Department of Urology, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, China
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35
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Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution. Prostate Cancer Prostatic Dis 2020; 24:169-176. [PMID: 32759972 DOI: 10.1038/s41391-020-0263-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transrectal (TR) and transperineal (TP) approaches for prostate biopsy have different morbidity profiles. Our institution transitioned to a preference for multiparametric MRI-based triage and TP biopsy since 2014. The aim of this study was to compare clinical, microbiological and health economic outcomes between TR and TP prostate biopsy. METHODS A consecutive cohort study considered prostate biopsies over an 11 year period. Hospital presentations across the region within 30 days of biopsy were analysed for details and subsequent outcomes according to biopsy approach. Cost for each encounter (routine and unplanned) were analysed and generalised linear models applied, as well as cost implications for inclusion of mpMRI-based triage and TP biopsy preference. RESULTS In total, 2048 prostate biopsies were performed. Similar re-presentation rates per occurred for each biopsy approach (90 patients, TR 4.8%, TP 3.8%, p = 0.29), with 23 patients presenting more than once (119 total presentations). Presentations after TR biopsy were more likely to be of infectious aetiology (TR 2.92%, TP 0.26% de novo, p < 0.001) and result in hospital admission (TR 43/49, 93.4%; TP 14/24, 58.3%; p = 0.007) for similar rates of urinary retention (TR 2.76% vs TP 3.63%, p = 1). The mean overall cost (biopsy and re-presentations) was higher for the TP group (p < 0.001), adjusted for year and age, but reduced over time and was similar for patients who re-presented (p = 0.98). Incorporation of mpMRI (with subsequently avoided biopsies), TP biopsy and re-presentations resulted in AU$783.27 saving per biopsy. CONCLUSIONS TR biopsy resulted in more infectious complications and hospital admissions than TP biopsy for similar rates of re-presentation and urinary retention. TP biopsy costs reduced over time and use in conjunction with mpMRI provides an overall cost saving. Routine TP biopsy is safe and feasible, with further cost savings expected with other approaches (local anaesthetic) under investigation.
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36
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Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Guo H, Gontero P. Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases. BJU Int 2020; 127:122-130. [PMID: 32455504 DOI: 10.1111/bju.15121] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the outcomes of multiparametric magnetic resonance imaging (mpMRI) transperineal targeted fusion biopsy (TPFBx) under local anaesthesia. PATIENTS AND METHODS We prospectively screened 1327 patients with a positive mpMRI undergoing TPFBx (targeted cores and systematic cores) under local anaesthesia, at two tertiary referral institutions, between September 2016 and May 2019, for inclusion in the present study. Primary outcomes were detection of clinically significant prostate cancer (csPCa) defined as (1) International Society of Urological Pathologists (ISUP) grade >1 or ISUP grade 1 with >50% involvement of prostate cancer (PCa) in a single core or in >2 cores (D1) and (2) ISUP grade >1 PCa (D2). Secondary outcomes were: assessment of peri-procedural pain (numerical rating scale [NRS]) and procedure timings; erectile (International Index of Erectile Function) and urinary (International Prostate Symptom Score) function changes; and complications. We also investigated the value of systematic sampling and concordance with radical prostatectomy (RP). RESULTS A total of 1014 patients were included, of whom csPCa was diagnosed in 39.4% (n = 400). The procedure was tolerable (NRS pain score 3.1 ± 2.3), with no impact on erectile (P = 0.45) or urinary (P = 0.58) function, and a low rate of complications (Clavien-Dindo grades 1 or 2, n = 8; grade >2, n = 0). No post-biopsy sepsis was recorded. Twenty-two men (95% confidence interval [CI] 17-29) needed to undergo additional systematic biopsy to diagnose one csPCa missed by targeted biopsies (D1). ISUP grade concordance of biopsies with RP was as follows: k = 0.40 (95% CI 0.31-0.49) for targeted cores alone and k = 0.65 (95% CI 0.57-0.72; P < 0.05) overall. CONCLUSIONS The use of TPFBx under local anaesthesia yielded good csPCa detection and was feasible, quick, well tolerated and safe. Infectious risk was negligible. Addition of systematic to targeted cores may not be needed in all men, although it improves csPCa detection and concordance with RP.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Junlong Zhuang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Mattia Beltrami
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Xiaozhi Zhao
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Yansheng Kan
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Haifeng Huang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Riccardo Faletti
- Department of, Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Qing Zhang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Luca Molinaro
- Department of, Pathology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Wei Wang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Laura Bergamasco
- Department of, Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Hongqian Guo
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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Grummet J, Gorin MA, Popert R, O'Brien T, Lamb AD, Hadaschik B, Radtke JP, Wagenlehner F, Baco E, Moore CM, Emberton M, George AK, Davis JW, Szabo RJ, Buckley R, Loblaw A, Allaway M, Kastner C, Briers E, Royce PL, Frydenberg M, Murphy DG, Woo HH. "TREXIT 2020": why the time to abandon transrectal prostate biopsy starts now. Prostate Cancer Prostatic Dis 2020; 23:62-65. [PMID: 31932659 PMCID: PMC7027966 DOI: 10.1038/s41391-020-0204-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/11/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Michael A Gorin
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Erik Briers
- European Cancer Patient Coalition, Brussels, Belgium
| | - Peter L Royce
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Declan G Murphy
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Henry H Woo
- Sydney Adventist Hospital, University of Sydney, Sydney, NSW, Australia
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38
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Infectious complications of prostate biopsy: winning battles but not war. World J Urol 2020; 38:2743-2753. [PMID: 32095882 DOI: 10.1007/s00345-020-03112-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications. OBJECTIVE AND METHODS In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined. RESULTS Management of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy. CONCLUSIONS Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members-included MDRs-although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.
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39
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A noninferiority within-person study comparing the accuracy of transperineal to transrectal MRI-US fusion biopsy for prostate-cancer detection. Prostate Cancer Prostatic Dis 2020; 23:449-456. [PMID: 31953483 PMCID: PMC7423592 DOI: 10.1038/s41391-020-0205-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/05/2020] [Accepted: 01/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) and ultrasound (US) fusion prostate-biopsies can be performed in a transrectal (TR-fusion) or transperineal (TP-fusion) approach. Prospective comparative evidence is limited. In this study we compared the detection rate of clinically-significant prostate-cancer (csPCa) within an index lesion between TR and TP-fusion. PATIENTS AND METHODS This was a prospective, noninferiority, and within-person trial. Men scheduled for MRI-US-fusion with a discrete MRI PI-RRAD ≥ 3 lesion were included. A dominant index lesion was determined for each subject and sampled by TR and TP-fusion during the same session. The order of biopsies was randomized and equipment was reset to avoid chronological and incorporation bias. For each subject, the index lesion was sampled 4-6 times in each approach. All biopsies were performed using Navigo fusion software (UC-Care, Yokneam, Israel). csPCa was defined as: Grade Group ≥ 2 or cancer-core length ≥ 6 mm. We used a noninferiority margin of 10% and a one-sided alpha level of 5%. RESULTS Seventy-seven patients completed the protocol. Median age was 68.2 years (IQR:64.2-72.2), median PSA was 8.9 ng/ml (IQR:6.18-12.2). Ten patients (13%) were biopsy naive, others (87%) had a previous biopsy. csPCa was detected in 32 patients (42%). All of these cases were detected by TP-fusion, while only 20 (26%) by TR-fusion. Absolute difference for csPCa diagnosis was 15.6 (CI 90% 27.9-3.2%) in favor of TP-fusion (p = 0.029). TP-fusion was noninferior to TR-fusion. The lower boundary of the 90% confidence-interval between TP-fusion and TR-fusion was greater than zero, therefore TP-fusion was also found to be superior. Exploratory subgroup analyses showed TP-fusion was consistently associated with higher detection rates of csPCa compared with TR-fusion in patient and index-lesion derived subgroups (size, location, PI-RADS, PSA, and biopsy history). CONCLUSIONS In this study, TP-fusion biopsies were found to be noninferior and superior to TR-fusion biopsies in detecting csPCa within MRI-visible index lesion. Centers experienced in both TP and TR-fusion should consider these results when choosing biopsy method.
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40
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Wajswol E, Winoker JS, Anastos H, Falagario U, Okhawere K, Martini A, Treacy P, Voutsinas N, Knauer CJ, Sfakianos JP, Lewis SC, Taouli BA, Rastinehad AR. A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection. BJU Int 2019; 125:531-540. [DOI: 10.1111/bju.14957] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ethan Wajswol
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Jared S. Winoker
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Harry Anastos
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ugo Falagario
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Kennedy Okhawere
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Alberto Martini
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Nicholas Voutsinas
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Cynthia J Knauer
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - John P. Sfakianos
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Sara C. Lewis
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Bachir A. Taouli
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ardeshir R. Rastinehad
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
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41
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Huang GL, Kang CH, Lee WC, Chiang PH. Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study. BMC Urol 2019; 19:101. [PMID: 31660936 PMCID: PMC6816188 DOI: 10.1186/s12894-019-0539-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated. Methods A total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score. Results The cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085). Conclusions Patients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.
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Affiliation(s)
- Guan-Lin Huang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, Taiwan, Republic of China
| | - Chih-Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, Taiwan, Republic of China
| | - Wei-Ching Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, Taiwan, Republic of China
| | - Po-Hui Chiang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, Taiwan, Republic of China.
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He BM, Chen R, Shi ZK, Xiao GA, Li HS, Lin HZ, Ji J, Peng HX, Wang Y, Sun YH, Wang HF. Trans-Perineal Template-Guided Mapping Biopsy vs. Freehand Trans-Perineal Biopsy in Chinese Patients With PSA < 20 ng/ml: Similar Cancer Detection Rate but Different Lesion Detection Rate. Front Oncol 2019; 9:758. [PMID: 31448239 PMCID: PMC6696794 DOI: 10.3389/fonc.2019.00758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/29/2019] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to investigate the diagnostic efficacy and the regional location of prostate cancer (PCa) as well as the accuracy of assessment between trans-perineal template-guided mapping biopsy (TTMB) and freehand trans-perineal biopsy (FTPB) for men with PSA < 20 ng/ml. Thus, we evaluated 623 consecutive patients with PSA < 20 ng/ml who had prostate biopsies in our institute between July 2017 and September 2018. Patients were divided into two groups based on different biopsy methods: 217 (34.83%) patients with TTMB and 406 (65.17%) with FTPB. Thirty six patients with TTMB and 80 with FTPB had continued undergone radical prostatectomy after a cancer diagnosis. Then the Gleason score of the biopsy and the post-radical prostatectomy specimens in each patient were compared. Overall, the PCa detection rate was 34.35%. There was no significant difference in PCa detection rate between TTMB and FTPB (35.48 vs. 33.74%, respectively; p = 0.663). Besides, the detection rate of significant PCa (Gleason score ≥ 7) in TTMB was 29.03% while FTPB was 23.89% (p = 0.162). The detection rate at the apex of the prostate was higher than the detection rate at the base of the prostate (9.80 vs. 5.79%; p < 0.01) when performing the TTMB. The FTPB would miss 10% of the positive diagnosis and almost half of the lesions. The upgraded of Gleason score from biopsy to post-radical prostatectomy was 16.67% with the TTMB and 36.25% with the FTPB (p = 0.034). The TTMB had a similar cancer detection rate, but a higher lesion detection rate and more accuracy in assess the actual Gleason score when comparing to FTPB for men with PSA < 20 ng/ml. By performing a 20-core TTMB, the cancer detection rate at the apex of the prostate was higher than the base.
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Affiliation(s)
- Bi-Ming He
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhen-Kai Shi
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Guang-An Xiao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hu-Sheng Li
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Heng-Zhi Lin
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jin Ji
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hong-Xiang Peng
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yan Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ying-Hao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hai-Feng Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
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Tafuri A, Ashrafi AN, Palmer S, Shakir A, Cacciamani GE, Iwata A, Iwata T, Cai J, Sali A, Gupta C, Medina LG, Stern MC, Duddalwar V, Aron M, Gill IS, Abreu A. One-Stop MRI and MRI/transrectal ultrasound fusion-guided biopsy: an expedited pathway for prostate cancer diagnosis. World J Urol 2019; 38:949-956. [PMID: 31175460 DOI: 10.1007/s00345-019-02835-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/01/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the feasibility, safety, and outcomes of an expedited One-Stop prostate cancer (PCa) diagnostic pathway. PATIENTS AND METHODS We identified 370 consecutive patients who underwent multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound fusion prostate biopsy (MRI/TRUS-PBx) from our institutional review board-approved database. Patients were divided according to diagnostic pathway: One-Stop (n = 74), with mpMRI and same-day PBx, or Standard (n = 296), with mpMRI followed by a second visit for PBx. mpMRIs were performed and interpreted according to Prostate Imaging-Reporting and Data System (PI-RADS v2). Grade group ≥ 2 PCa defined clinically significant PCa (csPCa). Statistical significance was considered when p < 0.05. RESULTS Age (66 vs 66 years, p = 0.59) and PSA density (0.1 vs 0.1 ng/mL2, p = 0.26) were not different between One-Stop vs Standard pathway, respectively. One-Stop patients lived further away from the hospital than Standard patients (163 vs 31 km; p < 0.01), and experienced shorter time from mpMRI to PBx (0 vs 7 days; p < 0.01). The number (p = 0.56) and distribution of PI-RADS lesions (p = 0.67) were not different between the groups. All procedures were completed successfully with similar perioperative complications rate (p = 0.24). For patients with PI-RADS 3-5 lesions, the csPCa detection rate (49% vs 41%, p = 0.55) was similar for One-Stop vs Standard, respectively. The negative predictive value of mpMRI (PI-RADS 1-2) for csPCa was 78% for One-Stop vs 83% for Standard (p = 0.99). On multivariate analysis, age, prostate volume and PI-RADS score (p < 0.01), but not diagnostic pathway, predicted csPCa detection. CONCLUSION A One-Stop PCa diagnostic pathway is feasible, safe, and provides similar outcomes in a shorter time compared to the Standard two-visit diagnostic pathway.
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Affiliation(s)
- Alessandro Tafuri
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Akbar N Ashrafi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Palmer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aliasger Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Atsuko Iwata
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tsuyoshi Iwata
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Akash Sali
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chhavi Gupta
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luis G Medina
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariana C Stern
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
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Kumsar Ş, Karabay E, Yüksel O, Şengör F. Surgical and functional outcomes of radical retropubic prostatectomy after biopsy-related acute prostatitis. Cent European J Urol 2019; 72:19-22. [PMID: 31011435 PMCID: PMC6469011 DOI: 10.5173/ceju.2018.1825] [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: 11/27/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The present study sought to evaluate the intraoperative, postoperative, oncologic, and functional results of radical prostatectomy (RP) after previous prostatitis. Material and methods We retrospectively reviewed available data of 320 patients undergoing open radical prostatectomy between 2010 and 2016. From this group, 23 (7.2%) had previous transrectal prostate biopsy-related acute prostatitis history. The perioperative and postoperative data were statistically compared between Group 1 (with previous prostatitis) and Group 2 (without previous prostatitis). The variables that were evaluated included demographic characteristics, perioperative complications, functional and oncological outcomes. Results In Group 1, the operative time, hospitalization and bladder catheterization time was statistically increased by 40 min, 1.9 days, and 2.5 days, respectively (p <0.001, p <0.001, p = 0.02). The positive margin rate was not significantly different between the two groups (p = 0 .64). The rate of complications with Clavien >2 increased in Group 1 (G1 26% vs. G2 12%) (p = 0.02). Neurovascular bundle preservation ratio was statistically higher in Group 2 (G1 46.5% vs. G2 76.9%) (p = 0.02). The functional results were similar for both groups 12 months after surgery. Conclusions Previously, transrectal prostate biopsy-related acute prostatitis history was associated with a higher operative time, hospitalization and bladder catheterization time, and perioperative complications during RP. According to our study, although the neurovascular bundle preservation is technically more difficult, potency and urinary continence rate was not affected by previous prostatitis history. However, further studies are still required to confirm these results.
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Affiliation(s)
- Şükrü Kumsar
- Baskent University İstanbul Hospital, Department of Urology, Istanbul, Turkey
| | - Emre Karabay
- TC Saglik Bakanligi Haydarpasa Numune Egitim ve Arastirma Hastanesi, Department of Urology, Istanbul, Turkey
| | - Omer Yüksel
- TC Saglik Bakanligi Haydarpasa Numune Egitim ve Arastirma Hastanesi, Department of Urology, Istanbul, Turkey
| | - Feridun Şengör
- TC Saglik Bakanligi Haydarpasa Numune Egitim ve Arastirma Hastanesi, Department of Urology, Istanbul, Turkey
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Chen YC, Chen HW, Huang SP, Yeh HC, Li CC. Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy. Int Braz J Urol 2019; 44:1122-1128. [PMID: 30088727 PMCID: PMC6442191 DOI: 10.1590/s1677-5538.ibju.2018.0181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/15/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations. Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics. Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 – 0.78; P = 0.021). Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.
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Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hao-Wei Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Pin Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Chin Yeh
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis. World J Surg Oncol 2019; 17:31. [PMID: 30760274 PMCID: PMC6375152 DOI: 10.1186/s12957-019-1573-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Because conventional prostate biopsy has some limitations, optimal variations of prostate biopsy strategies have emerged to improve the diagnosis rate of prostate cancer. We conducted the systematic review to compare the diagnosis rate and complications of transperineal versus transrectal prostate biopsy. Main body of the abstract We searched for online publications published through June 27, 2018, in PubMed, Scopus, Web of Science, and Chinese National Knowledge Infrastructure databases. The relative risk and 95% confidence interval were utilized to appraise the diagnosis and complication rate. The condensed relative risk of 11 included studies indicated that transperineal prostate biopsy has the same diagnosis accuracy of transrectal prostate biopsy; however, a significantly lower risk of fever and rectal bleeding was reported for transperineal prostate biopsy. No clue of publication bias could be identified. Short conclusion To conclude, this review indicated that transperineal and transrectal prostate biopsy have the same diagnosis accuracy, but the transperineal approach has a lower risk of fever and rectal bleeding. More studies are warranted to confirm these findings and discover a more effective diagnosis method for prostate cancer. Electronic supplementary material The online version of this article (10.1186/s12957-019-1573-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianjian Xiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Huaqing Yan
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiangfeng Li
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Chen
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Xiangyi Zheng
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Marra G, Ploussard G, Futterer J, Valerio M. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach? World J Urol 2019; 37:277-287. [PMID: 30610359 DOI: 10.1007/s00345-018-02622-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP). METHODS We performed a literature search of peer-reviewed English language articles using PubMed and the words "prostate" AND "biopsy". Web search was implemented by manual search. RESULTS Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx-TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues. CONCLUSION The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
| | - Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Ristau BT, Allaway M, Cendo D, Hart J, Riley J, Parousis V, Albertsen PC. Free-hand transperineal prostate biopsy provides acceptable cancer detection and minimizes risk of infection: evolving experience with a 10-sector template. Urol Oncol 2018; 36:528.e15-528.e20. [PMID: 30446447 DOI: 10.1016/j.urolonc.2018.09.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Free-hand transperineal prostate (fTP-Bx) biopsy offers an alternative to transrectal prostate biopsy (TRUS-Bx) in the diagnosis of prostate cancer. Our objectives were to determine whether fTP-Bx achieves cancer detection rates comparable to historic TRUS-Bx cohorts; to determine infectious and other complications associated with fTP-B; and to propose a standardized fTP-Bx template. PATIENTS AND METHODS We present a single institution, retrospective review of fTP-Bx in 1,000 men with elevated prostate-specific antigen, abnormal digital rectal examination, or on an active surveillance protocol. A fan-like biopsy scheme was used in 883 patients. A 10-sector prostate biopsy template was developed for use in the final 117 patients. The primary outcome was detection of any cancer and detection of clinically significant cancer (Grade Group ≥ 2). Secondary outcomes included procedural specifics and complications. Chi Square and Mann-Whitney U were used for analysis of categorical and continuous variables, respectively. RESULTS The median age of the cohort was 68 (interquartile range 61-74) years, and the median prostate-specific antigen was 7.9 (interquartile range 5.5-11.9) ng/ml. Total cancer (60.7%) and clinically significant cancer (40.3%) detection for fTP-Bx were comparable to those reported for TRUS-Bx. Detection of any cancer (70.9% vs. 59.3%, P < 0.01) and clinically significant cancer (51.3% vs. 38.9%, P = 0.01) was higher using the 10-sector biopsy template relative to the fan-like pattern. No patients were hospitalized for sepsis and no culture-proven urinary tract infections were diagnosed. CONCLUSION Cancer detection rates using fTP-Bx are comparable to TRUS-Bx, and fTP-Bx nearly eliminates the risk of infection. We propose a 10-sector biopsy template for fTP-Bx that easily translates to established MRI prostate sector maps for use in clinical care and future research studies exploring the efficacy of MRI-guided fTP-Bx.
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Filson CP. Quality of care and economic considerations of active surveillance of men with prostate cancer. Transl Androl Urol 2018; 7:203-213. [PMID: 29732278 PMCID: PMC5911536 DOI: 10.21037/tau.2017.08.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta Veterans Administration Medical Center, Decatur, GA, USA
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50
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Thurtle D, Starling L, Leonard K, Stone T, Gnanapragasam VJ. Improving the safety and tolerability of local anaesthetic outpatient transperineal prostate biopsies: A pilot study of the CAMbridge PROstate Biopsy (CAMPROBE) method. JOURNAL OF CLINICAL UROLOGY 2018; 11:192-199. [PMID: 29881622 PMCID: PMC5977271 DOI: 10.1177/2051415818762683] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/24/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to pilot the use of a bespoke device (CAMPROBE, the CAMbridge PROstate Biopsy) to enable routine outpatient free-hand local anaesthetic (LA) transperineal prostate biopsies. MATERIALS AND METHODS The CAMPROBE prototype was designed and built in our institution. Men on active surveillance due prostate resampling were invited to have a CAMPROBE biopsy as an alternative to repeat transrectal ultrasound-guided prostate biopsies (TRUSBx) as part of an approved trial (NCT02375035). Biopsies were performed using LA infiltration only, without sedation or additional analgesia. Patient-reported outcomes were recorded at day 0 and 7 using validated questionnaires and visual analogue scales (VAS). Complications were recorded prospectively. RESULTS Thirty men underwent biopsies with a median of 11 cores taken per procedure (interquartile range 10-12). There were no infections, sepsis or retention episodes. Haematuria and haematospermia occurred in 67% and 62% of patients, which are similar to rates reported for TRUSBx. Mean VAS for pain (0-10 scale) was less than 3 for every part of the procedure. All 30 men described the procedure as tolerable under LA. In total, 26/30 (86.7%) men expressed a preference for a CAMPROBE procedure over TRUSBx and a further 3 (10.0%) would have either. CONCLUSIONS In this small pilot study, the CAMPROBE device and method appears to be a safe, simple and well-tolerated out-patient transperineal replacement for TRUSBx. A major new National Institute for Health Research grant will allow its further development from a prototype to a single use, low-cost disposable device ready for multi-centre testing. LEVEL OF EVIDENCE 1b: individual cohort study.
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Affiliation(s)
- D Thurtle
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
| | - L Starling
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
| | - K Leonard
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
| | - T Stone
- Medical Physics and Clinical Engineering, Addenbrooke’s Hospital, Cambridge, UK
| | - VJ Gnanapragasam
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
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