Diagnostic efficacy and safety of transperineal prostate targeted and systematic biopsy: The preliminary experience of first 100 cases
https://doi.org/10.4081/aiua.2021.2.127
Accepted: December 28, 2020
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background: Post-biopsy urosepsis is a major concern for patient morbidity and cost. Trasperineal biopsy is reported to have less complications and higher detection rate of clinically significant prostate cancer (csPCa).
Objectives: To determine the diagnostic efficacy and safety of transperineal prostate biopsy in patients with elevated prostatic specific antigen (PSA).
Material and methods: A prospective study included men with elevated PSA > 3 ng/ml and previous negative biopsy from January 2018 to April 2019. All patients had multiparametric magnetic resonance imaging (mpMRI) and suspicious lesions reported as Prostate Imaging Reporting and Data System (PIRADS) score version 2. Average twelve systematic and two targeted cores were biopsied under general anaesthesia. Patients received single dose of antibiotic prebiopsy.
Results: 100 Consecutive patients having median age 64.0 years and median PSA of 6.1ng/ml were included for mpMRI-US fusion transperineal biopsies. Cancer detection rate was 45% (targeted 38% and systematic 22%) and csPCa were detected in 75.55% (targeted 86.84% and systematic 59.09%). MRI-US fusion targeted biopsies detected 63.88% csPCa in PIRADS 5, 33.33% in PIRADS 4 and 5.88% in PIRADS 3 lesions. PSA > 10 (p = 0.012), PSA density > 0.15 (p = 0.0002), and PIRADS 5 (0.0001) were significantly associated with PCa. Factors like Age (0.0001), initial PSA (0.022) and PSA density (0.006) were significant on univariate analysis while age (0.0001) was significant on multivariate analysis. There was no case of urinary tract infection.
Conclusions: Transperineal prostate biopsy is safe and effective in diagnosing csPCa. There is no risk of sepsis and major complications.
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011; 61:69-90. DOI: https://doi.org/10.3322/caac.20107
Loeb S, Carter HB, Berndt SI, et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011; 186:1830. DOI: https://doi.org/10.1016/j.juro.2011.06.057
Bennett HY, Roberts MJ, Doi SA, et al. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect. 2016; 144:1784-91. DOI: https://doi.org/10.1017/S0950268815002885
Liss MA, Ehdaie B, Loeb S, et al. An update of the American Urological Association White Paper on the prevention and treatment of the more common complications related to prostate biopsy. J Urol. 2017; 198:329. DOI: https://doi.org/10.1016/j.juro.2017.01.103
Davis P, Paul E, Grummet J. Current practice of prostate biopsy in Australia and New Zealand: A survey. Urol Ann. 2015; 7:315-9. DOI: https://doi.org/10.4103/0974-7796.152017
Grummet J, Pepdjonovic L, Huang S, et al. Transperineal vs. transrectal biopsy in MRI targeting. Transl Androl Urol. 2017; 6:368. DOI: https://doi.org/10.21037/tau.2017.03.58
Roberts MJ, Bennett HY, Harris PN, et al. Prostate Biopsy-related Infection: A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches. Urology. 2017; 104:11-21. DOI: https://doi.org/10.1016/j.urology.2016.12.011
Pepdjonovic L, Tan GH, Huang S, et al. Zero hospital admissions for infection after 577 transperineal prostate biopsies using singledose cephazolin prophylaxis. World J Urol. 2017; 35:1199. DOI: https://doi.org/10.1007/s00345-016-1985-1
Murphy DG and Grummet JP. Planning for the post-antibiotic era - why we must avoid TRUS-guided biopsy sampling. Nat Rev Urol. 2016; 13:559-60. DOI: https://doi.org/10.1038/nrurol.2016.176
D'Amico AV, Tempany CM, Cormack R, et al. Transperineal magnetic resonance image guided prostate biopsy. J Urol. 2000; 164:385-7. DOI: https://doi.org/10.1016/S0022-5347(05)67366-1
Pepe P, Garufi A, Priolo GD, et al. Multiparametric MRI/TRUS Fusion Prostate Biopsy: Advantages of a Transperineal Approach. Anticancer Res. 2017; 37:3291-3294. DOI: https://doi.org/10.21873/anticanres.11695
Hansen NL, Kesch C, Barrett T, et al. Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int. 2017; 120:631-8. DOI: https://doi.org/10.1111/bju.13711
Radtke JP, Schwab C, Wolf MB, et al. Multiparametric magnetic resonance imaging (MRI) and MRI-transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen. Eur Urol. 2016; 70:846-53. DOI: https://doi.org/10.1016/j.eururo.2015.12.052
Tan N, Margolis DJ, Lu DY, et al. Characteristics of detected and missed prostate cancer foci on 3-T multiparametric MRI using an endorectal coil correlated with whole-mount thin-section histopathology. AJR Am J Roentgenol. 2015; 205:W87-92. DOI: https://doi.org/10.2214/AJR.14.13285
Le JD, Tan N, Shkolyar E, et al. Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology. Eur Urol. 2015; 67:569-76. DOI: https://doi.org/10.1016/j.eururo.2014.08.079
Seo JW, Shin SJ, Taik Oh Y, et al. PI-RADS version 2: detection of clinically significant cancer in patients with biopsy gleason score 6 prostate cancer. AJR Am J Roentgenol. 2017; 209:W1-9. DOI: https://doi.org/10.2214/AJR.16.16981
Matoso A, Epstein JI. Defining clinically significant prostate cancer on the basis of pathological findings. Histopathology. 2019; 74:135-145. DOI: https://doi.org/10.1111/his.13712
Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2011; 59:61-71. DOI: https://doi.org/10.1016/j.eururo.2010.10.039
Thompson JE, Moses D, Shnier R, et al. Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study. J Urol. 2014; 192:67-74. DOI: https://doi.org/10.1016/j.juro.2014.01.014
Arumainayagam N, Ahmed HU, Moore CM, et al. Multiparametric MR imaging for detection of clinically significant prostate cancer: a validation cohort study with transperineal template prostate mapping as the reference standard. Radiology. 2013;268:761-9. DOI: https://doi.org/10.1148/radiol.13120641
Zhao C, Gao G, Fang D, et al. The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS version 2 in the diagnosis of clinically significant prostate cancer. Clin Imaging. 2016; 40:885-8. DOI: https://doi.org/10.1016/j.clinimag.2016.04.010
Rosenkrantz AB, Verma S, Choyke P, et al. Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol. 2016; 196:1613-8. DOI: https://doi.org/10.1016/j.juro.2016.06.079
Hakozaki Y, Matsushima H, Kumagai J, et al. A prospective study of magnetic resonance imaging and ultrasonography (MRI/US) fusion targeted biopsy and concurrent systematic transperineal biopsy with the average of 18-cores to detect clinically significant prostate cancer. BMC Urology. 2017; 17:117. DOI: https://doi.org/10.1186/s12894-017-0310-7
Valerio M, Donaldson I, Emberton M, et al. Detection of clinically significant prostate cancer using magnetic resonance imagingultrasound fusion targeted biopsy: a systematic review. Eur Urol. 2015; 68:8-19. DOI: https://doi.org/10.1016/j.eururo.2014.10.026
D'Agostino D, Mineo Bianchi F, Romagnoli D, et al. MRI/TRUS FUSION guided biopsy as first approach in ambulatory setting: Feasibility and performance of a new fusion device. Arch Ital Urol Androl. 2020; 91:211-217. DOI: https://doi.org/10.4081/aiua.2019.4.211
Vyas L, Acher P, Kinsella J, et al. Indications, results and safety profile of transperineal sector biopsies (TPSB) of the prostate: a single centre experience of 634 cases. BJU Int. 2014; 114:32-37. DOI: https://doi.org/10.1111/bju.12282
Loeb S, van den Heuvel S, Zhu X, et al. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012; 61:1110-4. DOI: https://doi.org/10.1016/j.eururo.2011.12.058
Chang DT, Challacombe B, Lawrentschuk N. Transperineal biopsy of the prostate-is this the future? Nat Rev Urol. 2013; 10:690-702. DOI: https://doi.org/10.1038/nrurol.2013.195
Gaziev G, Wadhwa K, Barrett T, et al. Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusionguided transperineal prostate biopsies as a validation tool. BJU Int. 2016; 117:80-6. DOI: https://doi.org/10.1111/bju.12892
Donato P, Morton A, Yaxley J, et al. Improved detection and reduced biopsies: the effect of a multiparametric magnetic resonance imaging-based triage prostate cancer pathway in a public teaching hospital. World J Urol. 2020; 38:371-379. DOI: https://doi.org/10.1007/s00345-019-02774-y
Pepe P, Aragona F. Morbidity after transperineal prostate biopsy in 3000 patients undergoing 12 vs 18 vs more than 24 needle cores. Urology. 2013; 81:1142-1146. DOI: https://doi.org/10.1016/j.urology.2013.02.019
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
