Morbidity of Transrectal MRI-Fusion Targeted Prostate Biopsy at a Tertiary Referral Academic Centre: An Audit to Guide the Transition to the Transperineal Approach

Development and validation of a nomogram model for predicting acute urinary retention after transrectal prostate biopsy

Background

Post-biopsy acute urinary retention (AUR) is still a common complication, often leading to extended hospital stays and greater patient discomfort. This study aimed to develop and validate a nomogram for the early identification of AUR after transrectal prostate biopsy (TRPB).

Methods

We collected data on patients who underwent TRPB at The Third Affiliated Hospital of Sun Yat-sen University between January 2019 and November 2023, including all characteristics and prostate morphological parameters. A total of 403 patients were screened for eligibility, and after strict screening, 333 patients were included in the study. These patients were randomly divided into a development cohort (n=233) and a validation cohort (n=100) in a 7:3 ratio. Moreover, the International Prostate Symptom Score (IPSS) and quality of life (QoL) before and after biopsy were collected for 66 patients with AUR with varying post-void residual urine volumes (PVR). Additionally, the voiding situation after catheter removal was also documented. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for AUR. The performance of the nomogram was assessed via calibration curves, Harrell's concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) analysis.

Results

The PVR (200-300 mL) group showed significantly lower IPSS and QoL on post-biopsy day 7 compared to the 301-500 mL and >500 mL groups (P<0.05 and P<0.001, respectively). Additionally, the PVR (200-300 mL) group had the highest urinary catheter removal success rate. Univariate and multivariate logistic regression analyses identified 3 clinical factors-hypercholesteremia, prostatic urethral length (PUL), and the prostatic urethral angle (PUA)-that are significantly correlated with the AUR. This nomogram exhibited strong discriminative ability in both the development and validation cohorts, with an area under the curve (AUC) of 0.834 [95% confidence interval (CI): 0.772-0.896] in the development cohort and an AUC of 0.895 (95% CI: 0.831-0.958) in the validation cohort. The Hosmer-Lemeshow test indicated a well-fitted calibration curve (P=0.69). Furthermore, DCA and the CIC suggested favorable clinical utility for the nomogram.

Conclusions

Here, we first determined that patients unable to void with a PVR >200 mL should be considered as having AUR and developed a nomogram to predict its occurrence, facilitating individualized medical treatment after TRPB.

Transrectal versus transperineal prostate fusion biopsy: a pair-matched analysis to evaluate accuracy and complications

PURPOSE

To evaluate biopsy-related complications and detection rates of any PCa and clinically significant PCa (csPCa, intended as grade group ≥ 2) between MRI-targeted TP fusion biopsies (TPBx) and TR ones (TRBx).

METHODS

We performed a multicentric study on 4841 patients who underwent fusion biopsy between 2016 and 2023. A case-control matching was performed to find comparable cohorts of 646 TPBx and 646 TRBx. Mean T test and Pearson chi-square tests were used to compare continuous and categorical variables.

RESULTS

Baseline characteristics were comparable between the cohorts, except for target location with a higher rate of anterior lesions in TPBx group. Complications were rare and no difference was found between the groups, with similar rates of infections after TRBx and TPBx (N = 5 (0.8%) vs N = 2 (0.3%), p 0.45). All patients in TRBx and 90.1% in TPBx group received antibiotic prophylaxis. A higher csPCa detection rate was found in TPBx over the group (50.5% vs 36.2%, p < 0.001). On average, positive targeted cores were increased in TPBx group, for any PCa (1.6 vs 1.4, p 0.04) and csPCa (1.0 vs 0.8, p 0.02). Among the limitations of study, we acknowledge the retrospective design and the possible under-reporting of complications.

CONCLUSIONS

MRI-targeted fusion TPBx achieves a significantly higher csPCa detection than TRBx, with a diagnostic advantage for apical and anterior lesions. No significant differences were found in terms of complications that were rare in both groups, considering a widespread adoption of antibiotic prophylaxis.

Transrectal Prostate Biopsy Approach in Men Undergoing Kidney Transplant: A Retrospective Cohort Study at Three Referral Academic Centers

BACKGROUND

Currently, there are no studies evaluating the feasibility of a prostate biopsy approach in men undergoing a kidney transplant (KT). Owing to this evidence, we planned a retrospective population-based study to evaluate our experience of a transrectal prostate biopsy (TR-PB) approach and studied the impact on the complication rate and outcomes in patients undergoing KT with suspected prostate cancer (PCa).

METHODS

We collected data from KT patients who underwent PB with a transrectal approach. One week and two weeks after the PB, patients' information was collected regarding possible complications during the post-biopsy period.

RESULTS

A total of 121 patients were included in this study. Among them, Group 1 was composed of 59 patients undergoing TR-PB with an ultrasound (US) standard technique, and Group 2 consisted of 62 patients undergoing TR-PB with an MRI-US cognitive technique. We observed a 28.9% Clavien-Dindo grade ≤ 2 of early side effect rates (mostly rectal bleeding and other minor hematuria), with a very low rate of hospital re-admission for acute urinary retention (3.3%); only one man required hospitalization for rectal bleeding, and there were no major complications.

CONCLUSIONS

We can affirm that TR-PB can be a safe procedure with a low risk of severe complications when performed by skilled specialists with a standardized procedural pathway.