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Mac Curtain BM, Temperley HC, Kelly JAO, Ryan J, Qian W, O'Sullivan N, Breen KJ, Mc Carthy CJ, Brennan I, Davis NF. The role of urology and radiology in prostate biopsy: current trends and future perspectives. World J Urol 2024; 42:249. [PMID: 38649544 DOI: 10.1007/s00345-024-04967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Prostate biopsy is central to the accurate histological diagnosis of prostate cancer. In current practice, the biopsy procedure can be performed using a transrectal or transperineal route with different technologies available for targeting of lesions within the prostate. Historically, the biopsy procedure was performed solely by urologists, but with the advent of image-guided techniques, the involvement of radiologists in prostate biopsy has become more common. Herein, we discuss the pros, cons and future considerations regarding their ongoing role. METHODS A narrative review regarding the current evidence was completed. PubMed and Cochrane central register of controlled trials were search until January 2024. All study types were of consideration if published after 2000 and an English language translation was available. RESULTS There are no published studies that directly compare outcomes of prostate biopsy when performed by a urologist or radiologist. In all published studies regarding the learning curve for prostate biopsy, the procedure was performed by urologists. These studies suggest that the learning curve for prostate biopsy is between 10 and 50 cases to reach proficiency in terms of prostate cancer detection and complications. It is recognised that many urologists are poorly able to accurately interpret multi parametric (mp)-MRI of the prostate. Collaboration between the specialities is of importance with urology offering the advantage of being involved in prior and future care of the patient while radiology has the advantage of being able to expertly interpret preprocedure MRI. CONCLUSION There is no evidence to suggest that prostate biopsy should be solely performed by a specific specialty. The most important factor remains knowledge of the relevant anatomy and sufficient volume of cases to develop and maintain skills.
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Affiliation(s)
| | | | - John A O Kelly
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - James Ryan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Wanyang Qian
- Dept of Surgery, St John of God Midland Hospital, Midland, WA, USA
| | | | - Kieran J Breen
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - Colin J Mc Carthy
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Ian Brennan
- Department of Radiology, St James Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
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Hu JC, Assel M, Allaf ME, Ehdaie B, Vickers AJ, Cohen AJ, Ristau BT, Green DA, Han M, Rezaee ME, Pavlovich CP, Montgomery JS, Kowalczyk KJ, Ross AE, Kundu SD, Patel HD, Wang GJ, Graham JN, Shoag JE, Ghazi A, Singla N, Gorin MA, Schaeffer AJ, Schaeffer EM. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial. Eur Urol 2024:S0302-2838(23)03342-0. [PMID: 38212178 DOI: 10.1016/j.eururo.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND OBJECTIVE The transrectal biopsy approach is traditionally used to detect prostate cancer. An alternative transperineal approach is historically performed under general anesthesia, but recent advances enable transperineal biopsy to be performed under local anesthesia. We sought to compare infectious complications of transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis. METHODS We assigned biopsy-naïve participants to undergo transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis (rectal culture screening for fluoroquinolone-resistant bacteria and antibiotic targeting to culture and sensitivity results) through a multicenter, randomized trial. The primary outcome was post-biopsy infection captured by a prospective medical review and patient report on a 7-d survey. The secondary outcomes included cancer detection, noninfectious complications, and a numerical rating scale (0-10) for biopsy-related pain and discomfort during and 7-d after biopsy. KEY FINDINGS AND LIMITATIONS A total of 658 participants were randomized, with zero transperineal versus four (1.4%) transrectal biopsy infections (difference -1.4%; 95% confidence interval [CI] -3.2%, 0.3%; p = 0.059). The rates of other complications were very low and similar. Importantly, detection of clinically significant cancer was similar (53% transperineal vs 50% transrectal, adjusted difference 2.0%; 95% CI -6.0, 10). Participants in the transperineal arm experienced worse periprocedural pain (0.6 adjusted difference [0-10 scale], 95% CI 0.2, 0.9), but the effect was small and resolved by 7-d. CONCLUSIONS AND CLINICAL IMPLICATIONS Office-based transperineal biopsy is tolerable, does not compromise cancer detection, and did not result in infectious complications. Transrectal biopsy with targeted prophylaxis achieved similar infection rates, but requires rectal cultures and careful attention to antibiotic selection and administration. Consideration of these factors and antibiotic stewardship should guide clinical decision-making. PATIENT SUMMARY In this multicenter randomized trial, we compare prostate biopsy infectious complications for the transperineal versus transrectal approach. The absence of infectious complications with transperineal biopsy without the use of preventative antibiotics is noteworthy, but not significantly different from transrectal biopsy with targeted antibiotic prophylaxis.
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Affiliation(s)
- Jim C Hu
- Brady Department of Urology, New York Presbyterian Weill Cornell Medicine Hospital, New York, NY, USA.
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Cohen
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin T Ristau
- Department of Surgery, Division of Urology, UConn Health, Farmington, CT, USA
| | - David A Green
- Brady Department of Urology, New York Presbyterian Weill Cornell Medicine Queens, New York, NY, USA
| | - Misop Han
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Rezaee
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ashley E Ross
- Department of Urology, Northwestern Medicine, Northwestern University, Chicago, IL, USA
| | - Shilajit D Kundu
- Department of Urology, Northwestern Medicine, Northwestern University, Chicago, IL, USA
| | - Hiten D Patel
- Department of Urology, Northwestern Medicine, Northwestern University, Chicago, IL, USA
| | - Gerald J Wang
- Brady Department of Urology, New York Presbyterian Weill Cornell Medicine Queens, New York, NY, USA
| | - John N Graham
- Brady Department of Urology, New York Presbyterian Weill Cornell Medicine Brooklyn, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ahmed Ghazi
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Anthony J Schaeffer
- Department of Urology, Northwestern Medicine, Northwestern University, Chicago, IL, USA
| | - Edward M Schaeffer
- Department of Urology, Northwestern Medicine, Northwestern University, Chicago, IL, USA
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Fang JH, Zhang L, Xie X, Zhao P, Bao L, Kong F. Comparative diagnostic accuracy of multiparametric magnetic resonance imaging-ultrasound fusion-guided biopsy versus systematic biopsy for clinically significant prostate cancer. PeerJ 2023; 11:e16614. [PMID: 38107582 PMCID: PMC10725670 DOI: 10.7717/peerj.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To examine the accuracy of transperineal magnetic resonance imaging (MRI)-ultrasound (US) fusion biopsy (FB) in identifying men with prostate cancer (PCa) that has reached a clinically relevant stage. Methods This investigation enrolled 459 males. In 210 of these patients (FB group), transperineal MRI/US fusion-guided biopsies were performed on the suspicious region, and in 249 others, a systematic biopsy (SB) was performed (SB group). We compared these groups using Gleason scores and rates of cancer detection. Results PCa cases counted 198/459 (43.1%), including 94/249 (37.8%) in the SB group and 104/210 (49.5%) in the FB group. FB was associated with higher overall diagnostic accuracy relative to SB (88.5% and 72.3%, P = 0.024). FB exhibited greater sensitivity than SB (88.9% and 71.2%, P = 0.025). The area under the curve for FB and SB approaches was 0.837 and 0.737, respectively, such that FB was associated with an 11.9% increase in accuracy as determined based upon these AUC values. Relative to SB, FB was better able to detect high-grade tumors (GS ≥ 7) (78.85% vs. 60.64%, P = 0.025). Conclusion Transperineal MRI-US fusion targeted biopsy is superior to the systematic one as an approach to diagnosing clinically significant PCa, as it is a viable technical approach to prostate biopsy.
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Affiliation(s)
- Jian-hua Fang
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Liqing Zhang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Xi Xie
- Department of Urology Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Pan Zhao
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Lingyun Bao
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Fanlei Kong
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
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Wong J, McGuffin M, Smith M, Loblaw DA. The use of virtual reality hypnosis for prostate cancer patients during transperineal biopsy/gold seed implantation: A needs assessment study. J Med Imaging Radiat Sci 2023; 54:429-435. [PMID: 37268549 DOI: 10.1016/j.jmir.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Patients having radiation therapy treatment to the prostate may require invasive preparation procedures under local anesthesia (LA), such as the insertion of gold seeds into the prostate or targeted biopsies. These procedures can induce pain and anxiety for some patients. Virtual Reality Hypnosis (VRH) is the combination of a 360-degree video display with audio and mental guides for relaxation and distraction during medical procedures. The objective of this research was to assess the level of patient interest in the use of VRH during gold seed insertion and biopsy, and to identify a subset of patients that would be most likely to benefit from the use of VRH. METHODS This single arm, prospective pilot study included patients who were receiving biopsy and/or gold seed insertion using a 2-step LA procedure. Participants were asked to complete a questionnaire about their level of knowledge and interest in VRH before and after their procedure. At the same time, pain and anxiety levels were collected before and after the procedure, as well as during each LA step and at the mid-seed drop/biopsy core extraction. A visual analogue scale for pain and the National Comprehensive Cancer Network's Distress Thermometer were used to verbally rate pain and distress respectively. Descriptive statistics and Pearson's correlation coefficient were calculated for all variables of interest. RESULTS 24 patients were recruited and 1 had their procedure cancelled, so a total of 23 patients completed this study. 74% of patients (n=23) agreed to try VRH before their procedures, whereas 65% of patients (n=23) were willing to try VRH after the procedure. Pain scores were highest at deep LA injection (mean= 5.48, SD= 2.56) and distress scores were also highest at deep LA injection (mean= 4.28, SD= 2.92). After the procedure, 83% of participants with pain scores above the mean at deep LA injection and 80% with anxiety scores above the mean at deep LA injection agreed that they would be willing to try VRH. CONCLUSIONS Patients with higher pain and distress scores had more interest in trying VRH with the standard LA for gold seed insertion/biopsy procedures. Patients with a history of lower pain tolerance or who express having experienced high levels of pain during previous biopsies will be the target population for using VRH in future trials to determine feasibility and effectiveness.
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Affiliation(s)
- Jane Wong
- The Michener Institute of Education at UHN, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Merrylee McGuffin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Dr Andrew Loblaw
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lu M, Luo Y, Wang Y, Yu J, Zheng H, Yang Z. Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients. BMC Urol 2023; 23:11. [PMID: 36709292 PMCID: PMC9883893 DOI: 10.1186/s12894-023-01176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Transrectal (TR) ultrasound guided prostate biopsy and transperineal (TP) ultrasound guided prostate biopsy are the two most commonly used methods to detect prostate cancer, the detection rate of the two biopsy approaches may differ in patients with different clinical characteristics. Here we aimed to compare the prostate cancer detection rate and positive rate of biopsy cores between TR and TP prostate biopsy in patients with different clinical characteristics. METHODS We retrospectively analyzed and compared the clinical data of 452 patients underwent TR or TP prostate biopsy in our hospital from June 2017 to September 2021. And patients were stratified according to several clinical characteristic (serum PSA level, prostate volume, PSA density, T stage and ISUP grade), cancer detection rate and positive rate of biopsy cores were compared in different stratified groups. RESULTS There was no significant difference in age, PSA level, prostate volume, and PSA density between the TR and TP groups. TR group had a higher overall cancer detection rate and positive rate of biopsy cores than TP group. Further subgroup analysis showed that TR group had a higher cancer detection rate in patients with prostate volumes 30-80 mL, and that the TR group had a higher positive rate of biopsy cores among the patients with T3-T4 stages, while TP group had a higher positive rates of biopsy cores among the patients with T1-T2 stages. There were no significant differences between the TR and TP groups for each subgroup when stratified by PSA level, PSA density and ISUP grade. CONCLUSIONS TR approach may have advantage in patients with prostate volumes 30-80 mL and T3-T4 stages, while TP approach may have advantage in patients with T1-T2 stages.
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Affiliation(s)
- Mengxin Lu
- grid.413247.70000 0004 1808 0969Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071 Hubei China
| | - Yi Luo
- grid.413247.70000 0004 1808 0969Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071 Hubei China
| | - Yongzhi Wang
- grid.413247.70000 0004 1808 0969Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071 Hubei China
| | - Jingtian Yu
- grid.413247.70000 0004 1808 0969Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071 Hubei China
| | - Hang Zheng
- grid.413247.70000 0004 1808 0969Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071 Hubei China
| | - Zhonghua Yang
- grid.413247.70000 0004 1808 0969Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071 Hubei China
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Lenfant L, Barret E, Rouprêt M, Rozet F, Ploussard G, Mozer P; Cancerology Committee of Association Française d'Urologie (CCAFU). Transperineal Prostate Biopsy Is the New Black: What Are the Next Targets? Eur Urol 2022:S0302-2838(22)01602-5. [PMID: 35216857 DOI: 10.1016/j.eururo.2022.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/24/2022]
Abstract
Transperineal biopsy is recommended as the first-choice technique for diagnosis of prostate cancer owing to lower rates of postprocedural sepsis. However, unresolved issues such as biopsy quality, lack of a systematic biopsy template, cost-effectiveness, and the risk of acute urine retention are yet to be resolved by the urological community.
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Setia S, Jackson J, Cendo D, Gorin MA, Allaway M, Vourganti S. Assessing the diagnostic performance of systematic freehand PrecisionPoint transperineal prostate biopsy: Comparison of observed outcomes to PBCG nomogram predictions. Urol Oncol 2021; 40:4.e9-4.e17. [PMID: 34688533 DOI: 10.1016/j.urolonc.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/08/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We assessed the diagnostic performance of freehand systematic transperineal biopsy (fTPb) by using the Prostate Biopsy Collaborative Group (PBCG) nomogram, which is a contemporary update to the PCPT nomogram. METHODS From 1/2012 to 12/2018, fTPb was performed on consecutive men with clinical suspicion of prostate cancer. Patients included in this study had no previous diagnosis of prostate cancer, PSA between 2.5 ng/ml and 20 ng/ml, and underwent at least 12 core biopsies. In addition, those men who underwent pre-biopsy multiparametric magnetic resonance imaging of the prostate were considered separately from those without prebiopsy imaging. Biopsies were performed by a single urologist who developed the needle guidance device used in the procedure. Clinical and pathological data were collected retrospectively. We compared observed biopsy outcomes with those predicted by PBCG nomogram utilizing chi-square statistical analysis. RESULTS Systematic fTPb (without pre-biopsy MRI) was performed in 301 men (median age 67, mean PSA 6.9 ng/mL). These men had a median of 20 biopsy cores. Clinically significant cancer (ISUP 2 or greater) was found in 33.9% of men. In men without pre-biopsy MRI, using PBCG Nomogram, we found no significant difference between the expected and observed number of clinically significant cancer (96 vs. 102; P = 0.09). An additional 73 men (median age 67, mean PSA 7.8 ng/ml) underwent pre-biopsy MRI imaging. The addition of MRI targets to systematic sampling resulted in a median of 25 cores. Clinically significant cancer was found in 49.3%. Using the PBCG Nomogram, in the men with pre-biopsy MRI we found clinically significant cancer in significantly more men than was expected by PBCG nomogram predictions (36 vs. 20; P = <0.01). There were no biopsy-related infectious complications. CONCLUSION The fTPb technique is a promising method to sample the prostate which provides cancer detection that is comparable to that expected from systematic TRUS biopsy. We found that pre-biopsy mpMRI resulted in greater than expected detection of clinically significant cancer when utilizing this technique.
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Affiliation(s)
- Shaan Setia
- Rush University Medical Center, Department of Urology, Chicago, Illinois
| | - Jamaal Jackson
- Rush University Medical Center, Department of Urology, Chicago, Illinois
| | | | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew Allaway
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA
| | - Srinivas Vourganti
- Rush University Medical Center, Department of Urology, Chicago, Illinois.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Al-Mitwalli A, Kyriazis G, El-Taji O, Chandra E, Deborah W, Burns P, Fady Y, Simms M, Nicholas S. Selective transperineal prostate biopsy for fluoroquinolone-resistance patients reduces sepsis and cost. Curr Urol 2021; 15:115-8. [PMID: 34168531 DOI: 10.1097/CU9.0000000000000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Urosepsis is a recognized complication of transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Pre-biopsy rectal swabs have been used to identify patients with microorganisms in the rectal flora resistant to the conventionally used empirical prophylaxis. The transperineal route of biopsy (TP-Bx) has a lower complication risk but comes at an increased cost. Materials and methods: Retrospective cohort study including patients undergoing prostate biopsies between October/2015 and April/2018. The intervention cohort, a rectal swab was performed, the result of which dictated the biopsy route; TRUS-Bx against TP-Bx. TP-Bx for patients with fluoroquinolone resistance or extended-spectrum β-lactamase. The control cohort underwent TRUS without a rectal swab receiving empirical antibiotics—oral ciprofloxacin and intravenous gentamicin. Results: Total 1000 patients were included in which 500 underwent a swab, 14 (2.8%) developed post-TRUS biopsy infective complications with 3 having positive bacteremia (0.6%); 500 had no swab, 47 (9.4%) developed post-TRUS biopsy infective complications with 22 (4.4%, p < 0.05) having positive bacteremia. Three patients (0.6%) of patients who underwent swab developed urinary tract infection symptoms whilst 12 (2.4%) had urinary tract infection in the control group. In those patients that underwent a swab, 14 required hospitalization with mean length of stay of 2.5 days versus 43 patients of the control with 3.6 days. Cost analysis concluded savings of this strategy was £18,711. Conclusions: We have demonstrated a protocol that reserves template biopsies for higher risk patients and can significantly reduce sepsis and other infectious complication rates whilst also proving to be a cost-efficient strategy. We recommend that units not utilizing rectal swabs to uncover the fluoroquinolone resistance rate by introducing them. We advocate units that already utilize rectal swabs, to introduce transperineal biopsy for their higher risk patients.
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12
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Lee AY, Chen K, Law YM, Ho HS, Cheng CW, Yuen JS, Tay KJ. Robot-assisted Magnetic Resonance Imaging-ultrasound Fusion Transperineal Targeted Biopsy. Urology 2021; 155:46. [PMID: 34186128 DOI: 10.1016/j.urology.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate the key steps to perform robot-assisted magnetic resonance imaging-ultrasound fusion transperineal prostate biopsy. MATERIALS AND METHODS Men with suspicion of prostate cancer underwent 3-Tesla multi-parametric MRI and were assigned a Prostate Imaging Reporting and Data System v2 score (PI-RADS). The prostate outline and suspicious lesions were marked by our radiologist using our software to produce a 3-dimensional prostate MRI model. All biopsies were performed under general anaesthesia and the real-time transrectal ultrasound model is created and subsequently fused with the MRI model using non-rigid software fusion. Transperineal targeted and systematic biopsy were then performed under stereotactic guidance using our robot-assisted prostate biopsy platform. Our clinically significant prostate cancer (Grade group ≥2) detection rates were previously described.1 RESULTS: Out of the 433 patients who underwent targeted and systematic biopsy, clinically-significant cancer detection rate was 46% (85% for PI- RADS 5 vs 38% for PI-RADS 4 vs 16% for PI-RADS 3; P < .001). Our overall complication rate was 13%, out of which the majority were Clavien-Dindo I (99%). The most common complications encountered were urinary retention (10%) and significant gross hematuria requiring bladder irrigation (2%). A higher prostate volume was associated with greater odds of urinary retention (OR 1.4, 95% CI: 1.21-1.65, P < .001 for every 10 mL increase in prostate volume). There was only 1 reported case of mild urinary tract infection. CONCLUSION Robot-assisted transperineal prostate biopsy has established itself as a reliable and accurate method of prostate cancer detection with minimal morbidity.
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Affiliation(s)
- Alvin Ym Lee
- Department of Urology, Singapore General Hospital, Singapore.
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | - Henry Ss Ho
- Department of Urology, Singapore General Hospital, Singapore
| | - Christopher Ws Cheng
- Department of Urology, Singapore General Hospital, Singapore; Department of Urology, Sengkang General Hospital, Singapore
| | - John Sp Yuen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
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13
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Pramod SV, Safriadi F, Kuddah Y, Handoko RR. Affordable novel device (VY) for transperineal prostate biopsy: A trial on prostate mannequin. MethodsX 2021; 8:101417. [PMID: 34430312 PMCID: PMC8374447 DOI: 10.1016/j.mex.2021.101417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is the most frequent malignancy in men worldwide after lung cancer. The gold standard for diagnosing prostate cancer is prostate biopsy. There are two main approaches for diagnosing PCa: transrectal biopsy and transperineal biopsy. In Indonesia, transperineal approach is rarely done as a part of diagnostic work up. The most known method of transperineal biopsy is the fan technique, which is a difficult technique to perform, particularly when directing the needle to the target accurately. For this reason, we develop an affordable bioplastic VY probe mounted needle guide device ($10) to provide precise needle insertion during the biopsy. In this study, we assessed the objective and subjective factors of the newly developed VY device.•Basic knowledge and operation technique were equalized by holding a prostate biopsy training using fan technique and VY device to 20 first-year Residents•Participants were randomized and devided into two groups to perform fan technique and VY technique based on the training given•Subjective factors (usefulness, the easiness, and preference) and objective factors (duration of puncture to needle visualization on USG, biopsy duration time, and the ability to reach the target tissue) were evaluated.
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Affiliation(s)
- Sawkar Vijay Pramod
- Urology Department, Hasan Sadikin Academic Medical Center, Faculty of Medicine, Universitas Padjajaran Bandung, Jl. Pasteur No. 38 Bandung Jawa Barat, 40161 Indonesia
| | - Ferry Safriadi
- Urology Department, Hasan Sadikin Academic Medical Center, Faculty of Medicine, Universitas Padjajaran Bandung, Jl. Pasteur No. 38 Bandung Jawa Barat, 40161 Indonesia
| | - Yasser Kuddah
- Urology Department, Hasan Sadikin Academic Medical Center, Faculty of Medicine, Universitas Padjajaran Bandung, Jl. Pasteur No. 38 Bandung Jawa Barat, 40161 Indonesia
| | - Richardo Raditya Handoko
- Urology Department, Hasan Sadikin Academic Medical Center, Faculty of Medicine, Universitas Padjajaran Bandung, Jl. Pasteur No. 38 Bandung Jawa Barat, 40161 Indonesia
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Pepe P, Pepe L, Pennisi M, Fraggetta F. Giant retrovesical ectopic prostatic adenoma. Case report and revision of the literature. Urol Case Rep 2020; 33:101383. [PMID: 33102081 PMCID: PMC7574036 DOI: 10.1016/j.eucr.2020.101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022] Open
Abstract
We report a case of giant retrovesical adenoma originating from ectopic prostatic tissue. A 73-year-old man presented with progressive dysuria, increasing PSA values, and acute urinary retention. One year before presentation, the patient had undergone retropubic prostatic adenomectomy for benign prostate hyperplasia. At last admission, PSA value was 23 ng/ml; mpMRI demonstrated a dysomogeneus retrovesical mass of 8 cm in diameter. Biopsy histology demonstrated acute prostatitis of the residual parenchyma and a prostatic adenoma in the retrovesical mass. After antibiotics and restored spontaneous urination, the patient was discharged and refused surgical lesion removal. After three months, the patient remains asymptomatic.
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Affiliation(s)
- Pietro Pepe
- Urology Unit - Cannizzaro Hospital, Via Messina 829, Catania, Italy
| | - Ludovica Pepe
- Urology Unit - Cannizzaro Hospital, Via Messina 829, Catania, Italy
| | - Michele Pennisi
- Urology Unit - Cannizzaro Hospital, Via Messina 829, Catania, Italy
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16
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Marenco Jimenez JL, Claps F, Ramón-Borja JC, Mascarós Martinez JM, Gutierrez AW, Lozano ÁGF, Ramírez-Backhaus M, Domìnguez Escrig JL, Serra AC, Rubio-Briones J. Rebiopsy rate after transperineal or transrectal prostate biopsy. Prostate Int 2020; 9:78-81. [PMID: 34386449 PMCID: PMC8322821 DOI: 10.1016/j.prnil.2020.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022] Open
Abstract
Background In recent years, transperineal biopsies gained popularity for prostate cancer diagnosis; lower infective complications and improved sampling of the prostate are the main advantages of this technique. One question that remains unclear is whether an initial transperineal biopsy confers a lower risk for rebiopsy compared with the transrectal approach. Methods Six hundred seventy-one men were prospectively followed after an initial negative prostate biopsy for a median period of 49.50 (IQR: 37.62–61.17) months. Rebiopsy rate was analyzed attending to first biopsy approach (transrectal versus transperineal systematic) and clinical variables. Results Diagnostic rate was similar for transrectal and transperineal systematic biopsies. Targeted biopsies outperformed any systematic approach, and transperineal targeted in particular was superior to transrectal targeted. Rebiopsy rates were 15.4% and 5.26% for the transrectal and transperineal systematic groups, respectively. Prostate-specific antigen density and type of first biopsy were identified as rebiopsy predictors. Conclusion Men undergoing transperineal systematic biopsies had a three times lower rate of rebiopsy over the study period compared with the traditional transrectal approach. This advantage could be added to the already described potential benefits of transperineal biopsies. Targeted biopsies had lower rebiopsy rate over the study period. Further innovations that decreased the cost of transperineal biopsies could favor this approach in the future.
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Affiliation(s)
| | - Francesco Claps
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.,Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Juan C Ramón-Borja
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Augusto W Gutierrez
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Álvaro G F Lozano
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | | | - Argimiro C Serra
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Jose Rubio-Briones
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
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17
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Merrick GS, Kurko B, Scholl W, Butler WM, Adamovich E. CT-PLANNED transperineal prostate BIOPSY IN patients without a rectum. Urol Case Rep 2020; 33:101409. [PMID: 33102106 DOI: 10.1016/j.eucr.2020.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
A patient at risk of harboring prostate cancer with a history of ulcerative colitis surgically managed with total colectomy (including the distal rectum and anal canal) underwent CT-planned transperineal prostate biopsy with fluoroscopic guidance. We describe the planning and intraoperative technique to obtain prostate biopsy cores.
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18
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Noh TI, Tae JH, Kim HK, Shim JS, Kang SG, Sung DJ, Cheon J, Lee JG, Kang SH. Diagnostic Accuracy and Value of Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Targeted and Template Systematic Prostate Biopsy Based on Bi-parametric Magnetic Resonance Imaging. Cancer Res Treat 2020; 52:714-721. [PMID: 32054151 PMCID: PMC7373864 DOI: 10.4143/crt.2019.716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/05/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose of this study was to investigate the diagnostic value of magnetic resonance imaging (MRI)–ultrasound (US) fusion transperineal targeted biopsy (FTB) and fusion template systematic biopsy (FSB) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) (intermediate/high grade [Gleason score ≥ 3+4]) based on bi-parametric MRI (bpMRI). Materials and methods Retrospectively, we analyzed 300 patients with elevated prostate-specific antigen (≥ 4.0 ng/mL) and/or abnormal findings in a digital rectal examination at the Korea University Hospital. All 300 men underwent bpMRI-US fusion transperineal FTB and FSB in the period from April 2017 to March 2019. Results PCas were detected in 158 of 300 men (52.7%), and the prevalence of csPCa was 34.0%. CsPCas were detected in 12 of 102 (11.8%) with Prostate Imaging-Reporting and Data System (PI-RADS) 3, 42 of 92 (45.7%) with PI-RADS 4, respectively; and 45 of 62 (72.6%) men with PI-RADS 5, respectively. BpMRI showed a sensitivity of 95.1% and negative predictive value of 89.6% for csPCa. FTB detected additional csPCa in 33 men (12.9%) compared to FSB. Compared to FTB, FSB detected additional csPCa in 10 men (3.9%). Conclusion BpMRI-US FTB and FSB improved detection of PCa and csPCa. The accuracy of bi-parametric MRI is comparable with that of multi-parametric MRI. Further, it is rapid, simpler, cheaper, and no side effects of contrast media. Therefore, it is expected that bpMRI-US transperineal FTB and FSB could be a good alternative to conventional US-guided transrectal biopsy, which is the current gold standard.
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Affiliation(s)
- Tae Il Noh
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Jong Hyun Tae
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Hyung Keun Kim
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Deuk Jae Sung
- Department of Urology, Korea University School of Medicine, Seoul, Korea.,Department of Radiology, Korea University School of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
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19
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Amin A, Blazevski A, Scheltema M, Stricker P. Transperineal biopsy of the prostate in a patient post abdominoperineal resection. Urol Case Rep 2019; 28:101055. [PMID: 31763166 PMCID: PMC6861561 DOI: 10.1016/j.eucr.2019.101055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022] Open
Abstract
A 75-year-old man with a background history of total colectomy (including the distal rectum anal canal), has a suspicion of prostate cancer based on an elevated PSA and high risk features on multiparametric MRI. Here we describe the case in detail including the technique utilized to obtain prostate biopsy cores.
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Affiliation(s)
- Amer Amin
- St Vincent's Prostate Cancer Centre, Sydney, Australia.,School of Medicine, UNSW, Sydney, Australia.,Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Sydney, Australia
| | - Alexandar Blazevski
- St Vincent's Prostate Cancer Centre, Sydney, Australia.,School of Medicine, UNSW, Sydney, Australia.,Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Sydney, Australia
| | - Matthijs Scheltema
- Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Sydney, Australia.,Department of Urology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Phillip Stricker
- St Vincent's Prostate Cancer Centre, Sydney, Australia.,School of Medicine, UNSW, Sydney, Australia.,Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Sydney, Australia
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20
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Nakanishi Y, Ito M, Fukushima H, Yokoyama M, Kataoka M, Ikuta S, Sakamoto K, Takemura K, Suzuki H, Tobisu KI, Koga F. Who Can Avoid Systematic Biopsy Without Missing Clinically Significant Prostate Cancer in Men Who Undergo Magnetic Resonance Imaging-Targeted Biopsy? Clin Genitourin Cancer 2019; 17:e664-71. [PMID: 31003892 DOI: 10.1016/j.clgc.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of the study was to identify a subset of men who can avoid systematic multisite biopsy (SyB) among those undergoing magnetic resonance imaging (MRI)-targeted transperineal 4-core biopsy (TgB) without missing clinically significant cancer (SC). PATIENTS AND METHODS From April 2013 to December 2017, 304 men with elevated prostate-specific antigen levels (< 20 ng/mL) or abnormal digital rectal examination and positive MRI findings underwent transrecta ultrasound and MRI-targeted transperineal 4-core with 14-core systematic biopsy. MRI findings were prospectively collected and evaluated using Prostate Imaging-Reporting and Data System version 2 (PI-RADS), and scores ≥3 were considered positive. SC was defined as Gleason score ≥3 + 4 or maximum cancer length ≥5 mm. We evaluated the diagnostic performance of TgB and SyB to detect SC and characterized men who could avoid SyB without missing SC. RESULTS Detection rates of any cancer and SC for TgB/SyB/their combination were 59%/63%/68% and 51%/52%/61%, respectively. TgB alone missed 14% (29/207) of any cancer and 16% (29/184) of SC detected using TgB with SyB. In uni- and multivariable analyses, PI-RADS scores of 3 to 4 were independent predictors for missing SC using TgB alone. When restricted to 81 men with PI-RADS scores of 5 (27%), SC was missed using TgB alone only in 3 (4.6% vs. 22% for the remaining 223 men; P = .007). CONCLUSION SC was missed using TgB alone in a non-negligible proportion of men who underwent TgB and SyB. SyB might be safely avoided in men with PI-RADS score 5 lesions with reduced risks of missing SC.
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21
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Cimino S, Verze P, Venturino L, Alessio P, Migliara A, Imbimbo C, Mirone V, Russo GI, Morgia G. Complication Rate After Antibiotic Prophylaxis with Fosfomycin Versus Fluorochinolones or β-lactam Antibiotics in Patients Undergoing Prostate Biopsy: A Propensity Score-adjusted Analysis. Eur Urol Focus 2018; 6:370-375. [PMID: 30007542 DOI: 10.1016/j.euf.2018.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/18/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transrectal ultrasound-guided prostate biopsy (TRBx) or transperineal Bx (TPBx) are considered alternative approaches for the diagnosis of prostate cancer (PCa). However, urinary tract infection (UTI) or other complications could be more frequent in the TRBx approach. OBJECTIVE To determine the complication rate following different antimicrobial prophylaxis (AMP; fosfomycin trometamol [FT] vs ß-lactame or fluorochinolones [FQ]) in patients undergoing TRBx or TPBx. DESIGN, SETTING, AND PARTICIPANTS The analyses were based on prospectively collected data of a cohort of patients who underwent TRBx or TPBx for elevated prostate-specific antigen (PSA; ≥4ng/ml) or clinical suspicion of PCa, between September 2016 and March 2017. Patients received a single dose of 3g oral FT (group A) or, alternatively, FQ or ß-lactame (group B). INTERVENTION TRBx versus TPBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Adjustment variables consisted of age, PSA, biopsy technique (TPBx vs TRBx), and antibiotic prophylaxis (FT vs ß-lactame or FQ) using 1:1 propensity-score matching. Overall, 526 patients were considered, of whom 258 received FT (group A) and the other 258 received ß-lactame or FQ (group B). RESULTS AND LIMITATIONS Overall complications occurred in 390 (75.58%) and major complications in 67/516 (12.98%). Lower prevalence of UTIs was detected in group A (34.1%) compared with that in group B (43.4%; p=0.03), while similar rates of haematuria (54.7% vs 55.4%), haemospermia (39.5% vs 33.0%), and acute urinary retention (11.6% vs 9.3%) were detected in groups A and B. We found that group B (odds ratio [OR]: 1.54; p=0.03), I grade haematuria (OR: 6.17; p<0.01), and II grade haematuria (OR: 5.13; p<0.01) were significantly associated with increased risk of UTIs. CONCLUSIONS AMP with fluoroquinoles or ß-lactam antibiotics increased the rate of UTIs, when compared with FT, in patients undergoing TRBx or TPBx. The appearance of haematuria or haemospermia is associated with UTIs, suggesting the possibility of tailoring the strategy for prophylaxis in this category of patients. PATIENT SUMMARY In this study, comparing complications after transrectal ultrasound-guided prostate biopsy versus transperineal biopsy, prophylaxis with fluoroquinoles or ß-lactam antibiotics increased the rate of urinary tract infections when compared with fosfomycin trometamol, regardless of the type of biopsy approach.
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Affiliation(s)
- Sebastiano Cimino
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Verze
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luca Venturino
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Alessio
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Alfonso Migliara
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giuseppe Morgia
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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22
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Guillaumier S, Peters M, Arya M, Afzal N, Charman S, Dudderidge T, Hosking-Jervis F, Hindley RG, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Shah K, van der Meulen J, Virdi J, Winkler M, Emberton M, Ahmed HU. A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer. Eur Urol 2018; 74:422-429. [PMID: 29960750 PMCID: PMC6156573 DOI: 10.1016/j.eururo.2018.06.006] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/01/2018] [Indexed: 12/15/2022]
Abstract
Background Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects. Objective To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate. Design, setting, and participants This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%). Intervention Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies. Outcome measurements and statistical analysis The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality. Results and limitations The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up. Conclusions Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects. Patient summary In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.
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Affiliation(s)
- Stephanie Guillaumier
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Max Peters
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Manit Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Naveed Afzal
- Department of Urology, Dorset County Hospital NHS Trust, Dorset, UK
| | - Susan Charman
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Feargus Hosking-Jervis
- Division of Surgery and Interventional Sciences, University College London, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | | | - Neil McCartan
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Raj Nigam
- Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, UK
| | - Chris Ogden
- Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raj Persad
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Karishma Shah
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | | | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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23
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Marra G, Eldred-Evans D, Challacombe B, Van Hemelrijck M, Polson A, Pomplun S, Foster CS, Brown C, Cahill D, Gontero P, Popert R, Muir G. Pathological Concordance between Prostate Biopsies and Radical Prostatectomy Using Transperineal Sector Mapping Biopsies: Validation and Comparison with Transrectal Biopsies. Urol Int 2017; 99:168-176. [PMID: 28768264 DOI: 10.1159/000471491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/15/2017] [Indexed: 11/19/2022]
Abstract
Background/Aims/Objectives: Our aim was to evaluate the accuracy of systematic transperineal sector mapping biopsy (TPSMB) in predicting Gleason score (GS) at radical prostatectomy (RP), to compare its accuracy with standard transrectal ultrasound-guided biopsies (TRUS) and to establish the clinical impact of discordance between biopsies and RP on subsequent surgical management. METHODS Two hundred fifty-five patients from 2008 to 2013 who underwent RP following TPSMB (n = 204) or TRUS (n = 51), were included in this retrospective multi-institutional study. Concordance between biopsies and RPs GS was assessed both as percentages and with Cohen's Kappa coefficient. All mismatches between biopsies and RP were assessed for significance by 3 urologists using the Delphi method. RESULTS No differences were present among the groups. Concordance between biopsy and RP GS was 75.49% for TPSMB and 64.70% for TRUS. Kappa coefficient was 0.42 and 0.39 respectively. The Delphi method showed lower clinical impact of GS discordances for TPSMB with 7.8% of patients having significant change, thus being potentially more suitable for other treatment modalities, compared to TRUS (13.7%). CONCLUSIONS TPSMB had a higher accuracy for predicting the GS grade at RP showing superior GS concordance compared with standard TRUS. TPSMB provides an effective technique for systematic prostate biopsy to evaluate overall prostate cancer GS.
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Kesch C, Radtke JP, Popeneciu IV, Gasch C, Dieffenbacher SC, Klein T, Schlemmer HP, Wieczorek K, Zogal P, Hohenfellner M, Sakas G, Hadaschik BA. TOP: Prospective Evaluation of a Volume Based, Computer Assisted Method for Transperineal Optimized Prostate Biopsy. Urol Int 2017; 99:149-155. [PMID: 28346914 DOI: 10.1159/000458764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/03/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study is a prospective evaluation of a volume-based, computer-assisted method for transperineal optimized prostate (TOP) biopsy. The TOP algorithm automates core planning for systematic prostate biopsies using the 3-dimensional organ contour and an alterable volume for tumors to be excluded. SUBJECTS AND METHODS MRI-transrectal ultrasound fusion biopsy with MRI-targeted biopsies (TBs) and systematic-TOP biopsies were performed on 172 men between October 2013 and March 2014. Systematic biopsies were placed according to TOP for detection of tumor volumes >0.5 mL with a minimum of 80% organ coverage in prostates up to 50 mL (70% in larger organs). RESULTS Median 24 TOP cores and 3 MRI-TBs have been placed. Prostate cancer (PCa) was detected in 112 of 172 (65%) of men; TOP detected 109 (97%) and TB 62 (55%). Significant cancer (Gleason score ≥7) was detected in 75 (44%) of men and of these TOP detected 73 of 75 (97%) and TB 51 of 75 (68%). Overall, systematic-TOP sampling significantly outperformed TB for the detection of both, all PCa as well as significant PCa (p < 0.0001, p = 0.0005). CONCLUSION The TOP method is innovative by integrating the individual prostate volume and PCa volume detection thresholds. In the present cohort, it diagnosed more significant tumors than TB alone. However, at the same time, more low-risk tumors are detected.
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Affiliation(s)
- Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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25
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Ahallal Y, Sanchez-Salas R, Sivaraman A, Barret E, Secin F, Validire P, Rozet F, Galiano M, Cathelineau X. Clinical performance of transperineal template guided mapping biopsy for therapeutic decision making in low risk prostate cancer. Actas Urol Esp 2016; 40:615-620. [PMID: 27527686 DOI: 10.1016/j.acuro.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the role of Transperineal Template guided Mapping Biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa). METHODS We retroscpectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen<10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one third positive cores at first biopsy and<50% of the core involved. TTMB results were analyzed for Gleason score upgrading and upstaging as compared to initial TransRectal UltraSound (TRUS) biopsies and its influence on the change in the treatment decisions. RESULTS TTMB detected cancer in 64 (65%) patients. The upgrade, upstage and both were noted in 33% (n=21), 12% (n=8) and 7% (n=5) respectively of the detected cancers. The disease characteristics was similar to initial TRUS in 30 (48%) patients and TTMB was negative in 34 (35%) patients. Prostate volume was significantly smaller in patients with upgrade and/or upstage noted at TTMB (45.4 vs 37.9; P=.03). TTMB results influenced 73.5% of upgraded and/or upstaged patients to receive radical treatment while 81% of the patients with unmodified stage and/or grade continued active surveillance or focal therapy. CONCLUSIONS In patients with low risk PCa diagnosed by TRUS, subsequent TTMB demonstrated cancer upgrade and/or upstage in about one-third of the patients and resulted in eventual change in treatment decision.
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