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Augostini A, Wattengel BA, Mergenhagen KA. An evaluation of antimicrobial prophylaxis for transrectal prostate biopsies: A potential stewardship target. Am J Infect Control 2024:S0196-6553(24)00503-0. [PMID: 38782210 DOI: 10.1016/j.ajic.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Transrectal prostate biopsy (TRPB) is a common procedure used to obtain a prostate biopsy. Although generally safe, complications may occur including infection. Preprocedural antimicrobial prophylaxis is recommended to minimize risk of subsequent infection. METHODS This study is a retrospective chart review via the computerized patient record system from January 1, 2018 to February 28, 2022. The study included patients who underwent a TRPB at the Western New York, Syracuse, or Albany Stratton Veterans Affairs Healthcare Systems. RESULTS This study included a total of 932 patients who underwent TRPB. Postoperative infection occurred in 3.2% (n = 30) of patients within 14days of the TRPB. Of the 30 patients who developed an infection, 30% (n = 9) resulted in bacteremia. For the 932 patients evaluated, 24 different antibiotic regimens were used, none of which followed guideline recommendations. None of the regimens were found to have an impact on rates of subsequent infection. CONCLUSIONS The results of this study suggest a need for guideline adherence. There was no benefit to using the guideline-discordant regimens as they were not associated with a decreased risk of infection, and in many cases exposed patients to unnecessarily broad and prolonged antibiotic regimens.
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Affiliation(s)
- Anna Augostini
- Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, NY
| | - Bethany A Wattengel
- Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, NY
| | - Kari A Mergenhagen
- Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, NY.
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2
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Hao Y, Xie F, He J, Gu C, Zhao Y, Luo W, Song X, Shen J, Yu L, Han Z, He J. PLA inhibits TNF-α-induced PANoptosis of prostate cancer cells through metabolic reprogramming. Int J Biochem Cell Biol 2024; 169:106554. [PMID: 38408537 DOI: 10.1016/j.biocel.2024.106554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 02/28/2024]
Abstract
Previous studies have shown that phenyllactic acid (alpha-Hydroxyhydrocinnamic acid, 2-Hydroxy-3-phenylpropionic acid, PLA), a type of organic acid metabolite, has excellent diagnostic efficacy when used to differentiate between prostate cancer, benign prostatic hyperplasia, and prostatitis. This research aims to explore the molecular mechanism by which PLA influences the PANoptosis of prostate cancer (PCa) cell lines. First, we found that PLA was detected in all prostate cancer cell lines (PC-3, PC-3 M, DU145, LNCAP). Further experiments showed that the addition of PLA to prostate cancer cells could promote ATP generation, enhance cysteine desulfurase (NFS1) expression, and reduce tumor necrosis factor alpha (TNF-α) levels, thereby inhibiting apoptosis in prostate cancer cells. Notably, overexpression of NFS1 can inhibit the binding of TNF-α to serpin mRNA binding protein 1 (SERBP1), suggesting that NFS1 competes with TNF-α for binding to SERBP1. Knockdown of SERBP1 significantly reduced the level of small ubiquity-related modifier (SUMO) modification of TNF-α. This suggests that NFS1 reduces the SUMO modification of TNF-α by competing with SERBP1, thereby reducing the expression and stability of TNF-α and ultimately inhibiting apoptosis in prostate cancer cell lines. In conclusion, PLA inhibits TNF-α induced panapoptosis of prostate cancer cells through metabolic reprogramming, providing a new idea for targeted treatment of prostate cancer.
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Affiliation(s)
- Yinghui Hao
- Department of Biochemistry and Molecular Biology, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Fangmei Xie
- Department of Biochemistry and Molecular Biology, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Jieyi He
- Department of Biochemistry and Molecular Biology, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Chenqiong Gu
- Department of Biochemistry and Molecular Biology, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Ying Zhao
- Central Laboratory of Panyu Central Hospital, Guangzhou, China
| | - Wenfeng Luo
- Central Laboratory of Panyu Central Hospital, Guangzhou, China
| | - Xiaoyu Song
- Central Laboratory of Panyu Central Hospital, Guangzhou, China
| | - Jian Shen
- Central Laboratory of Panyu Central Hospital, Guangzhou, China
| | - Li Yu
- Department of Biochemistry and Molecular Biology, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China.
| | - Zeping Han
- Central Laboratory of Panyu Central Hospital, Guangzhou, China.
| | - Jinhua He
- Department of Biochemistry and Molecular Biology, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China; Central Laboratory of Panyu Central Hospital, Guangzhou, China; Rehabilitation Medicine Institute of Panyu District, Guangzhou, China.
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3
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Fletcher SA, Mamawala MM, Holler AE, Bhanji Y, Macura KJ, de la Calle CM, Pavlovich CP. Cumulative cancer locations on prostate biopsy and active surveillance outcomes in the MRI era. Prostate 2024. [PMID: 38476030 DOI: 10.1002/pros.24688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND To validate the use of a cumulative cancer locations (CCLO) score, a measurement of tumor volume on biopsy, and to develop a novel magnetic resonance imaging (MRI)-informed CCLO (mCCLO) score to predict clinical outcomes on active surveillance (AS). METHODS The CCLO score is a sum of uniquely involved sextants with prostate cancer on diagnostic + confirmatory biopsy. The mCCLO score incorporates MRI findings into the CCLO score. Participants included 1284 individuals enrolled on AS between 1994 and 2022, 343 of whom underwent prostate MRI. The primary outcome was grade reclassification (GR) to grade group ≥2 disease; the secondary outcome was receipt of definitive treatment. RESULTS Increasing CCLO and mCCLO risk groups were associated with higher risk of GR and undergoing definitive treatment (both p < 0.001). On multivariable analysis, increasing mCCLO score was associated with higher risk of GR and receipt of definitive treatment (hazard ratios [HRs] per 1-unit increase: 1.26 [95% confidence interval [CI]: 1.12-1.41] and 1.21 [95% CI: 1.07-1.36], respectively). The model using mCCLO score to predict GR (c-index: 0.671; 95% CI: 0.621-0.721) performed at least as well as models using the number of cores positive for cancer (0.664 [0.613-0.715]; p = 0.7) and the maximum percentage of cancer in a core (0.641 [0.585-0.696]; p = 0.14). CONCLUSIONS The CCLO score is a valid, objective metric to predict GR and receipt of treatment in a large AS cohort. The ability of the MRI-informed mCCLO to predict GR is on par with traditional metrics of tumor volume but is more descriptive and may benefit from greater reproducibility. The mCCLO score can be implemented as a shorthand, informative tool for counseling patients about whether to remain on AS.
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Affiliation(s)
- Sean A Fletcher
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mufaddal M Mamawala
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Albert E Holler
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yasin Bhanji
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katarzyna J Macura
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claire M de la Calle
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christian P Pavlovich
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Alargkof V, Engesser C, Breit HC, Winkel DJ, Seifert H, Trotsenko P, Wetterauer C. The learning curve for robotic-assisted transperineal MRI/US fusion-guided prostate biopsy. Sci Rep 2024; 14:5638. [PMID: 38454051 PMCID: PMC10920700 DOI: 10.1038/s41598-024-55492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
Transperineal fusion prostate biopsy has a considerable learning curve (LC). Robotic-assisted transperineal MRI/Ultrasound fusion-guided biopsy (RA-TP-FBx) may have an easier LC due to automatization. We aimed to assess the LC of RA-TP-FBx and analyze its most difficult steps. We prospectively analyzed cases randomized to a biopsy-naïve urology resident, the chief resident, and an expert urologist in RA-TP-FBx (controls). We also analyzed consecutive cases in the LC of the expert. The LC was defined by procedure time, PCa detection rate (including stratification by PI-RADS), entrustable professional activities (EPA) assessment scores, and the NASA task load index. We collectively performed 246 RA-TP-FBx with the Mona Lisa device. Procedure time for residents decreased steeply from maximum 53 min to minimum 10 min, while the mean procedure time for the expert was 9 min (range 17-5 min). PCa detection for PI-RADS-4 lesions was 57% for the naïve resident, 61% for the chief resident and 62% for the expert. There was also no difference in Pca detection for PI-RADS-4 lesions when comparing the first and second half of the experts' biopsies (p = 0.8). Maximum EPA score was registered after 22 cases. Workload steeply declined. Proficient RA-TP-FBx performance appears feasible after 22 cases regardless of previous experience.
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Affiliation(s)
- Viktor Alargkof
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Christian Engesser
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | | | - David Jean Winkel
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Helge Seifert
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Pawel Trotsenko
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
- Department of Urology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Christian Wetterauer
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria.
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5
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Irmakci I, Nateghi R, Zhou R, Vescovo M, Saft M, Ross AE, Yang XJ, Cooper LAD, Goldstein JA. Tissue Contamination Challenges the Credibility of Machine Learning Models in Real World Digital Pathology. Mod Pathol 2024; 37:100422. [PMID: 38185250 PMCID: PMC10960671 DOI: 10.1016/j.modpat.2024.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
Machine learning (ML) models are poised to transform surgical pathology practice. The most successful use attention mechanisms to examine whole slides, identify which areas of tissue are diagnostic, and use them to guide diagnosis. Tissue contaminants, such as floaters, represent unexpected tissue. Although human pathologists are extensively trained to consider and detect tissue contaminants, we examined their impact on ML models. We trained 4 whole-slide models. Three operate in placenta for the following functions: (1) detection of decidual arteriopathy, (2) estimation of gestational age, and (3) classification of macroscopic placental lesions. We also developed a model to detect prostate cancer in needle biopsies. We designed experiments wherein patches of contaminant tissue are randomly sampled from known slides and digitally added to patient slides and measured model performance. We measured the proportion of attention given to contaminants and examined the impact of contaminants in the t-distributed stochastic neighbor embedding feature space. Every model showed performance degradation in response to one or more tissue contaminants. Decidual arteriopathy detection--balanced accuracy decreased from 0.74 to 0.69 ± 0.01 with addition of 1 patch of prostate tissue for every 100 patches of placenta (1% contaminant). Bladder, added at 10% contaminant, raised the mean absolute error in estimating gestational age from 1.626 weeks to 2.371 ± 0.003 weeks. Blood, incorporated into placental sections, induced false-negative diagnoses of intervillous thrombi. Addition of bladder to prostate cancer needle biopsies induced false positives, a selection of high-attention patches, representing 0.033 mm2, and resulted in a 97% false-positive rate when added to needle biopsies. Contaminant patches received attention at or above the rate of the average patch of patient tissue. Tissue contaminants induce errors in modern ML models. The high level of attention given to contaminants indicates a failure to encode biological phenomena. Practitioners should move to quantify and ameliorate this problem.
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Affiliation(s)
- Ismail Irmakci
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ramin Nateghi
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Rujoi Zhou
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mariavittoria Vescovo
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Madeline Saft
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ashley E Ross
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ximing J Yang
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Lee A D Cooper
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jeffery A Goldstein
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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Zhou L, Xu LL, Zheng LL, Chen C, Xu L, Zeng JL, Li SY. Predictors of Gleason Grading Group Upgrading in Low-Risk Prostate Cancer Patients From Transperineal Biopsy After Radical Prostatectomy. Acad Radiol 2024:S1076-6332(24)00012-6. [PMID: 38233258 DOI: 10.1016/j.acra.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the predictors of Gleason Grading Group (GGG) upgrading in low-risk prostate cancer (Gleason score=3 + 3) from transperineal biopsy after radical prostatectomy (RP). MATERIALS AND METHODS The clinical data of 160 patients who underwent transperineal biopsy and RP from January 2017 to December 2022 were retrospectively analyzed. First, univariate and multivariate logistic regression analysis were used to obtain independent predictors of postoperative GGG upgrading. Then receiver operating characteristic curve was used to evaluate the diagnostic efficacy of predictors. Finally, Linear-by-Linear Association test was used to analyze the risk trends of patients in different predictor groups in the postoperative GGG. RESULTS In this study, there were 81 cases (50.6%) in the GGG concordance group and 79 cases (49.4%) in the GGG upgrading group. Univariate analysis showed age, free/total prostate-specific antigen (f/tPSA), proportion of positive biopsies, positive target of magnetic-resonance imaging (MRI) and positive target of contrast-enhanced ultrasound had significant effects on GGG upgrading (all P < .05). In multivariate logistic regression analysis, age (odds ratio [OR]=1.066, 95%CI=1.007-1.127, P = .027), f/tPSA (OR=0.001, 95%CI=0-0.146, P = .001) and positive target of MRI (OR=3.005, 95%CI=1.353-76.674, P = .007) were independent predictors. The prediction model (area under curve=0.751 P < .001) had higher predictive efficacy than all independent predictors. The proportion of patients in exposed group of different GGG increased with the level of GGG, but decreased in nonexposed group, and the linear trend was significantly different (all P < .001). CONCLUSION Age, f/tPSA, and positive target of MRI were independent predictors of postoperative GGG upgrading. The predictive model constructed had the best diagnostic efficacy.
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Affiliation(s)
- Ling Zhou
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Li-Long Xu
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Lin-Lin Zheng
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (C.C.)
| | - Li Xu
- Department of Urology Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (L.X.)
| | - Ji-Ling Zeng
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (J.Z.)
| | - Shi-Yan Li
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.).
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7
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Gereta S, Hung M, Alexanderani MK, Robinson BD, Hu JC. Evaluating the Learning Curve for In-office Freehand Cognitive Fusion Transperineal Prostate Biopsy. Urology 2023; 181:31-37. [PMID: 37579853 DOI: 10.1016/j.urology.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To define the learning curve of the in-office, freehand MRI-ultrasound cognitive fusion transperineal prostate biopsy (CTPB) by assessing cancer detection, biopsy core quantity and quality, procedure times, and complications over the initial experience. METHODS We reviewed 110 consecutive CTPB performed March 2021-September 2022 by a urologist inexperienced with the PrecisionPoint platform. The study period was divided into quarters to assess for temporal variation in outcomes. Univariable and multivariable analysis modeled the learning curve. RESULTS Across quarters, there were no differences in the detection of clinically significant prostate cancer (Q1:50%, Q2:52%, Q3:50%, Q4:48%, P > .9) or Gleason grade group upgrading by targeted vs systematic biopsy (P = .6). Median procedure times improved with experience (Q1:17 minutes, Q2:14 minutes, Q3:12 minutes, Q4:13 minutes, P = .018). On multivariable analysis, procedure times decreased by 1minute per 20 cases (P < .001). On linear regression, CTPB procedure times approximated transrectal biopsy times after 90 cases (P < .001). The histopathologic core quality did not differ, as evidenced by consistent core length (P = .13) and presence of minimal fibromuscular tissue (P > .9). The most common complications, hematuria and hematospermia, were similar across quarters (P = .7, P = .3, respectively). There was a single episode of urinary retention and no reported infections. CONCLUSION There is no evidence of a learning curve for CTPB as shown by consistent clinically significant prostate cancer detection, high-quality biopsy cores, and low complications. However, CTPB procedural times begin to approximate cognitive targeted transrectal biopsy times after 90 cases.
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Affiliation(s)
- Sofia Gereta
- Department of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX; Department of Urology, Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Michael Hung
- Department of Urology, Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | | | - Brian D Robinson
- Department of Pathology, Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Jim C Hu
- Department of Urology, Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
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8
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He BM, Yang QW, Shi ZK, Ji TR, Wang SD, Zhou H, Jin ZC, Yan ZC, Zhang JJ, Wang HF. Association of biopsy core number and location with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia: a secondary analysis of the APROPOS trial. Int J Surg 2023; 109:3061-3069. [PMID: 37526126 PMCID: PMC10583920 DOI: 10.1097/js9.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND APROPOS was a multicentre, randomized, blinded trial focus on investigating the perineal nerve block versus the periprostatic block in pain control for men undergoing a transperineal prostate biopsy. In the analysis reported here, the authors aimed to evaluate the association of biopsy core count and location with pain outcomes in patients undergoing a transperineal prostate biopsy under local anesthesia. METHODS APROPOS was performed at six medical centers in China. Patients with suspected prostate cancer were randomized to receive either a perineal nerve block or a periprostatic block (1:1), followed by a transperineal prostate biopsy. The secondary analysis outcomes were the worst pain experienced during the prostate biopsy and postbiopsy pain at 1,6, and 24 h. RESULTS Between 12 August 2020 and 20 July 2022, a total of 192 patients were randomized in the original trial, and 188 were involved in this analysis, with 94 patients per group. Participants had a median (IQR) age of 68 (63-72) and a median (IQR) prostate volume of 42.51 (30.04-62.84). The patient population had a median (IQR) number of biopsy cores of 15 (12-17.50), and 26.06% of patients had a biopsy cores count of more than 15. After adjusting the baseline characteristics, the number of biopsy cores was associated with the worst pain during the biopsy procedure in both the perineal nerve block group ( β 0.19, 95% CI: 0.12-0.26, P <0.001) and the periprostatic block group ( β 0.16, 95% CI: 0.07-0.24, P <0.001). A similar association was also evident for the postbiopsy pain at 1, 6, and 24 h. A lesser degree of pain in both groups at any time (r range -0.57 to -0.01 for both groups) was associated with biopsy cores from the peripheral zone of the middle gland, while other locations were associated with a higher degree of pain. In addition, the location of the biopsy core had less of an effect on pain during the biopsy (r range -0.01-0.25 for both groups) than it did on postbiopsy pain (r range -0.57-0.60 for both groups). CONCLUSIONS In this secondary analysis of a randomized trial, biopsy core count and location were associated with pain in patients undergoing a transperineal prostate biopsy under local anesthesia. These results may be helpful for making clinical decisions about the anesthetic approach for scheduled transperineal prostate biopsies.
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Affiliation(s)
- Bi-Ming He
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Qi-Wei Yang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Zhen-Kai Shi
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Tang-Rao Ji
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
- Department of Urology, Lanxi People’s Hospital, Lanxi, People’s Republic of China
| | - Shuai-Dong Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Hai Zhou
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Zhi-Chao Jin
- Department of Health Statistics, Naval Medical University, Shanghai
| | - Zhi-Chao Yan
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Jia-Jun Zhang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Hai-Feng Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
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9
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Ma X, Zhou F, Yang D, Chen Y, Li M, Wang P. miRNA Detection for Prostate Cancer Diagnosis by miRoll-Cas: miRNA Rolling Circle Transcription for CRISPR-Cas Assay. Anal Chem 2023; 95:13220-13226. [PMID: 37609704 DOI: 10.1021/acs.analchem.3c02231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Micro-RNA (miRNA) emerges as a promising type of biomarker for cancer diagnosis. There is an urgent need for developing rapid, convenient, and precise miRNA detection methods that may be conducted with limited laboratory facilities, especially in underdeveloped areas. Herein, we developed a miRNA detection method termed miRoll-Cas, where miRNA is first amplified by rolling circle transcription and then subject to CRISPR-Cas13a assay. Using miRoll-Cas, we realized the sensitive detection of multiple cancer-relevant miRNA markers (miR21, miR141, and Let7b) and specifically identified other variants of the Let7 family, which can accurately discriminate prostate cancer patients from healthy people. We envision that miRoll-Cas may be readily translated to clinical applications in the diagnosis of a variety of diseases beyond cancer.
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Affiliation(s)
- Xiaowei Ma
- Department of Laboratory Medicine, Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Center for DNA Information Storage, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Fei Zhou
- School of Life Sciences, Shanghai University, Shanghai 200444, China
| | - Donglei Yang
- Department of Laboratory Medicine, Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Center for DNA Information Storage, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yun Chen
- Department of Laboratory Medicine, Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Center for DNA Information Storage, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Min Li
- Department of Laboratory Medicine, Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Center for DNA Information Storage, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Pengfei Wang
- Department of Laboratory Medicine, Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Center for DNA Information Storage, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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10
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Irmakci I, Nateghi R, Zhou R, Ross AE, Yang XJ, Cooper LAD, Goldstein JA. Tissue contamination challenges the credibility of machine learning models in real world digital pathology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.28.23289287. [PMID: 37205404 PMCID: PMC10187357 DOI: 10.1101/2023.04.28.23289287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Machine learning (ML) models are poised to transform surgical pathology practice. The most successful use attention mechanisms to examine whole slides, identify which areas of tissue are diagnostic, and use them to guide diagnosis. Tissue contaminants, such as floaters, represent unexpected tissue. While human pathologists are extensively trained to consider and detect tissue contaminants, we examined their impact on ML models. We trained 4 whole slide models. Three operate in placenta for 1) detection of decidual arteriopathy (DA), 2) estimation of gestational age (GA), and 3) classification of macroscopic placental lesions. We also developed a model to detect prostate cancer in needle biopsies. We designed experiments wherein patches of contaminant tissue are randomly sampled from known slides and digitally added to patient slides and measured model performance. We measured the proportion of attention given to contaminants and examined the impact of contaminants in T-distributed Stochastic Neighbor Embedding (tSNE) feature space. Every model showed performance degradation in response to one or more tissue contaminants. DA detection balanced accuracy decreased from 0.74 to 0.69 +/- 0.01 with addition of 1 patch of prostate tissue for every 100 patches of placenta (1% contaminant). Bladder, added at 10% contaminant raised the mean absolute error in estimating gestation age from 1.626 weeks to 2.371 +/ 0.003 weeks. Blood, incorporated into placental sections, induced false negative diagnoses of intervillous thrombi. Addition of bladder to prostate cancer needle biopsies induced false positives, a selection of high-attention patches, representing 0.033mm2, resulted in a 97% false positive rate when added to needle biopsies. Contaminant patches received attention at or above the rate of the average patch of patient tissue. Tissue contaminants induce errors in modern ML models. The high level of attention given to contaminants indicates a failure to encode biological phenomena. Practitioners should move to quantify and ameliorate this problem.
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Affiliation(s)
| | | | | | | | | | | | - Jeffery A. Goldstein
- To whom correspondence should be addressed: Olson 2-455, 710 N. Fairbanks Ave, Chicago IL, 60611,
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He BM, Ka-Fung Chiu P, Tao T, Lan JH, Cai JT, Zhou SC, Li RB, Ren Y, Ka-Lun L, Xu RY, Chen JR, Lan D, Gao JL, Chu SG, Jin ZC, Huang FF, Shi ZK, Yang QW, Zhou H, Wang SD, Ji TR, Han QP, Wang CM, Chi-Fai N, Wang HF. Perineal nerve block versus periprostatic block for patients undergoing transperineal prostate biopsy (APROPOS): a prospective, multicentre, randomised controlled study. EClinicalMedicine 2023; 58:101919. [PMID: 37007736 PMCID: PMC10060616 DOI: 10.1016/j.eclinm.2023.101919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023] Open
Abstract
Background We aimed to investigate perineal nerve block versus periprostatic block in pain control for men undergoing a transperineal prostate biopsy. Methods In this prospective, randomised, blinded and parallel-group trial, men in six Chinese hospitals with suspected prostate cancer were randomly assigned (1:1) at the point of local anaesthesia to receive a perineal nerve block or periprostatic block and followed by a transperineal prostate biopsy. Centres used their usual biopsy procedure. Operators who performed anaesthesia were trained in both techniques before the trial and were masked to the randomised allocation until the time of anaesthesia and were not involved in the subsequent biopsy procedure and any assessment or analysis. Other investigators and the patients were masked until trial completion. The primary outcome was the level of the worst pain experienced during the prostate biopsy procedure. Secondary outcomes included pain (post-biopsy at 1, 6 and 24 h), changes in blood pressure, heart rate and breathing rate during the biopsy procedure, external manifestations of pain during biopsy, anaesthesia satisfaction, the detection rate of PCa and clinically significant PCa. This trial is registered on ClinicalTrials.gov, NCT04501055. Findings Between August 13, 2020, and July 20, 2022, 192 men were randomly assigned to perineal nerve block or periprostatic block, 96 per study group. Perineal nerve block was superior for the relief of pain during the biopsy procedure (mean 2.80 for perineal nerve block and 3.98 for periprostatic block; adjusted difference in means -1.17, P < 0.001). Although the perineal nerve block had a lower mean pain score at 1 h post-biopsy compared with the periprostatic block (0.23 vs 0.43, P = 0.042), they were equivalent at 6 h (0.16 vs 0.25, P = 0.389) and 24 h (0.10 vs 0.26, P = 0.184) respectively. For the change in vital signs during biopsy procedure, perineal nerve block was significantly superior to periprostatic block in terms of maximum value of systolic blood pressure, maximum value of mean arterial pressure and maximum value of heart rate. There are no statistical differences in average value of systolic blood pressure, average value of mean, average value of heart rate, diastolic blood pressure and breathing rate. Perineal nerve block was also superior to periprostatic block in external manifestations of pain (1.88 vs 3.00, P < 0.001) and anaesthesia satisfaction (8.93 vs 11.90, P < 0.001). Equivalence was shown for the detection rate of PCa (31.25% for perineal nerve block and 29.17% for periprostatic block, P = 0.753) or csPCa (23.96% for perineal nerve block and 20.83% for periprostatic block, P = 0.604). 33 (34.8%) of 96 patients in the perineal nerve block group and 40 (41.67%) of 96 patients in the periprostatic block group had at least one complication. Interpretation Perineal nerve block was superior to periprostatic block in pain control for men undergoing a transperineal prostate biopsy. Funding Grant 2019YFC0119100 from the National Key Research and Development Program of China.
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Affiliation(s)
- Bi-Ming He
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peter Ka-Fung Chiu
- SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Tao Tao
- Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Jian-Hua Lan
- Department of Urology, Guang'an People's Hospital of Sichuan Province, China
| | - Jian-Tong Cai
- Department of Urology, Shi Shi Municipal General Hospital, Fujian province, China
| | - Sheng-Cai Zhou
- Department of Urology, People's Hospital of Yiyuan County, Zibo City, Shandong, China
| | - Rong-Bing Li
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Ren
- Department of Medical Equipment, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - L.O. Ka-Lun
- SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong-Yao Xu
- Department of Urology, Shi Shi Municipal General Hospital, Fujian province, China
| | - Jian-Rong Chen
- Department of Urology, Shi Shi Municipal General Hospital, Fujian province, China
| | - Dong Lan
- Department of Urology, Guang'an People's Hospital of Sichuan Province, China
| | - Jin-Li Gao
- Department of Pathology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shu-Guang Chu
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhi-Chao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Fang-fang Huang
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen-Kai Shi
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi-Wei Yang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai Zhou
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuai-Dong Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tang-Rao Ji
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Urology, Lanxi People's Hospital, Lanxi, China
| | - Qi-Peng Han
- Department of Urology, People's Hospital of Yiyuan County, Zibo City, Shandong, China
| | - Chang-Ming Wang
- Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - N.G. Chi-Fai
- SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hai-Feng Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
- Corresponding author. Department of Urology, Shanghai East Hospital, No. 150, Jimo Road, Shanghai, 200120, China.
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New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles' operation. Insights Imaging 2023; 14:42. [PMID: 36929129 PMCID: PMC10020382 DOI: 10.1186/s13244-023-01384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/04/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Currently, a prostate biopsy is guided by transrectal ultrasound (US) alone. However, this biopsy cannot be performed in men without an anus. The aim of this study was to show the outcomes of a new transperineal US (TPUS)-guided biopsy technique in patients who underwent Miles' operation. METHODS Between April 2009 and March 2022, TPUS-guided biopsy was consecutively conducted in 9 patients (median, 71 years; range, 61-78 years) with high prostate-specific antigen values (22.60 ng/mL; 6.19-69.7 ng/mL). Their anuses were all removed due to rectal cancer. TPUS-guided biopsy was performed according to information on prostate magnetic resonance imaging. The technical success rate, cancer detection rate, and complication rate were recorded. Tumor sizes were compared between benign and cancer groups using an unpaired t-test with Welch's correction. RESULTS The new TPUS-guided biopsy was successfully performed in all patients. Cancer was detected in 77.8% (7/9) of the patients. These were all categorized as PI-RADS 5. Among them, the detection rate of significant cancer (Gleason score 7 or higher) was 66.7% (6/9). The median tumor size was 2.4 cm (1.7-3.1 cm). However, two patients were diagnosed with benign tissue with PI-RADS 3 or PI-RADS 4. Their median tumor size was 1.0 cm (0.8-1.2 cm). There was significant difference between the cancer and benign groups (p = 0.037) in terms of tumor size. Neither post-biopsy bleeding nor infections occurred. CONCLUSIONS New TPUS-guided biopsy technique may contribute to detecting large PI-RADS 5 prostate cancer in men after Miles' operation.
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Gul ZG, Yu M, Sharbaugh DR, Pekala KR, Lin JY, Sharbaugh AJ, Zhu TS, Worku H, Armann KM, Hudson CN, Hay JM, Grajales V, Yabes JG, Davies BJ, Jacobs BL. Utilizing a Questionnaire to Implement a Risk-Based Antibiotic Prophylaxis Protocol for Transrectal Prostate Biopsy. Urology 2023:S0090-4295(23)00147-4. [PMID: 36868411 DOI: 10.1016/j.urology.2022.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To develop and evaluate a risk-based antibiotic prophylaxis protocol for patients undergoing transrectal prostate biopsy. METHODS We created a risk-based protocol for antibiotic prophylaxis before transrectal prostate biopsy. Patients were screened for infection risk-factors with a self-administered questionnaire. The protocol was implemented from January 1, 2020 to March 31, 2020. We compared patient risk-factors, antibiotic regimens, and 30-day infection rates for patients undergoing transrectal prostate biopsies during the intervention and for a 3-month period before the intervention. RESULTS There were 116 prostate biopsies in the pre-intervention group and 104 in the intervention group. Although there was no significant difference in the number of high-risk patients between the two groups (48% vs 55%; p=0.33), the percentage of patients treated with augmented prophylaxis decreased from 74% to 45% (p=0.03). The duration of antibiotic administration and the median number of doses prescribed also decreased significantly. Despite significant decreases in antibiotic use, there were no differences in infection rates (5% vs 5%; p=0.90) or sepsis rates (1% vs 2%; p=0.60). CONCLUSION We developed a risk-based protocol for prophylactic antibiotics before prostate biopsy. The protocol was associated with less antibiotic use but did not lead to an increase in infectious complications.
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Affiliation(s)
| | - Michelle Yu
- University of Pittsburgh, Department of Urology
| | | | | | | | | | - Toby S Zhu
- University of Pittsburgh, School of Medicine
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14
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Berg S, Tully KH, Hoffmann V, Bahlburg H, Roghmann F, Müller G, Noldus J, Reike M. Assessment of complications after transperineal and transrectal prostate biopsy using a risk-stratified pathway identifying patients at risk for post-biopsy infections. Scand J Urol 2023; 57:41-46. [PMID: 36655512 DOI: 10.1080/21681805.2023.2168049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Evidence of transperineal (TP) superiority over transrectal (TR) biopsy is growing due to lower infectious complication rates. However, TR biopsy is the most common procedure, and it seems that a cross-over to TP is delayed by logistical challenges such as costs, complexity, and lack of experience. We investigate whether well-selected patients without any risk factors may further undergo TR biopsy if all precautions to avoid infections are warranted. MATERIALS AND METHODS Data were collected in our academic institution between August 2021 and March 2022 and after clinical implementation of the currently updated European Association of Urology guideline recommendations on the performance of prostate biopsy. Patients underwent either TP or TR biopsy according to a riskstratification based on risk factors of infectious complications. Follow-up asked for post-biopsy complications. Inverse Probability of Treatment Weighting (IPTW) propensity score was used to balance baseline characteristics. Complications were subdivided into infectious and non-infectious complications. RESULTS In total, 294 patients were included with 161 patients undergoing TR vs. 133 patients undergoing TP biopsy. Complication rates were 2.2% for TP vs. 5.5% for TR biopsy concerning all complications. Infectious complication rates only were 0.7% for TP vs. 1.8% for TR biopsy. After IPTW adjustment, differences were statistically significant different (p = 0.01). CONCLUSION Our study revealed that even in a well-selected patient cohort with presumably lower risk of infectious complications, TR biopsy leads to more post-biopsy complications than TP biopsy. This conclusion should motivate the urological community to switch to TP biopsy.
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Affiliation(s)
- Sebastian Berg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl Heinrich Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Vincent Hoffmann
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Henning Bahlburg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Guido Müller
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.,Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Moritz Reike
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Liu HQ, Ding W, Tao LS, Shen XD, Wang JW. Catheterization Before Transperineal Ultrasound-guided Prostate Biopsy and the Risk of Urethrorrhagia. Urology 2023; 171:23-28. [PMID: 36208675 DOI: 10.1016/j.urology.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/11/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the efficacy of catheterization before transperineal ultrasound-guided prostate biopsy in reducing risk of urethrorrhagia. Currently, transperineal ultrasound-guided prostate biopsy (TPPB) is one of the most commonly used measures to help diagnose prostate cancer. However, whether the retention of catheterization before transperineal ultrasound-guided prostate biopsy is associated with the reduced risk of urethrorrhagia remains uncertain. METHODS A cohort study was conducted in our hospital from January 2021 to September 2021. This study included 93 patients who participated in transperineal ultrasound-guided prostate biopsy. We compared the risk of urethrorrhagia in patients who underwent indwelling catheterization before biopsy and those who did that after biopsy, and performed an unadjusted analysis. We also analyzed the use of related confounding factors to limit the cohort of men, and applied propensity-score adjustment to control potential confounders. Analyses that restricted the cohort men with the related confounding factors and that used propensity-score adjustment to control for potential confounders. RESULTS A total of 93 men were recruited in the cohort study, and the numbers of patients in group 1 and group 2 were 64 and 29, respectively. There were 34 patients (53.1%) of urethrorrhagia in group 1, and 22 patients (75.8%) of urethrorrhagia in group 2. This was a significant difference between the 2 groups (P = .008). After adjusting for correlative factors, the preoperative catheterization is still a protective factor for postoperative urethrorrhagia through multivariate multiple piecewise linear regression analysis. CONCLUSION The result of this cohort study suggested that preoperative catheterization can significantly reduce the risk of urethrorrhagia.
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Affiliation(s)
- He-Qian Liu
- The Second People's Hospital of Wuhu, Wuhu city, Anhui, China
| | - Wei Ding
- The Second People's Hospital of Wuhu, Wuhu city, Anhui, China
| | - Ling-Song Tao
- The Second People's Hospital of Wuhu, Wuhu city, Anhui, China
| | - Xu-Dong Shen
- The Second People's Hospital of Wuhu, Wuhu city, Anhui, China
| | - Jia-Wei Wang
- The Second People's Hospital of Wuhu, Wuhu city, Anhui, China.
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Grauer R, Gorin MA, Sood A, Butaney M, Olson P, Farah G, Hanna Cole R, Jeong W, Abdollah F, Menon M. Impact of prostate biopsy technique on outcomes of the precision prostatectomy procedure. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000122. [PMID: 35892060 PMCID: PMC9260793 DOI: 10.1136/bmjsit-2021-000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/08/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo assess the impact of iterative changes in preoperative and postoperative biopsy techniques on the outcomes of men undergoing the precision prostatectomy procedure. Precision prostatectomy is a novel surgical treatment for prostate cancer that aims to maximally preserve erectogenic nerves via partial preservation of the prostate capsule.DesignRetrospective.SettingSingle tertiary care center.ParticipantsThis study included 120 patients who consented to undergo prostate cancer treatment with the precision prostatectomy procedure. Patients were originally enrolled in one of two separate prospective protocols studying precision prostatectomy.InterventionsPreoperatively, 60 patients were screened with transrectal (TR) biopsy and 60 were screened by transperineal (TP) biopsy. Ultimately, 117 patients underwent precision prostatectomy. Of the 43 postoperative biopsies, 19 were TR; 17 were TP with ultrasound; and 7 were TP with microultrasound (mUS).Main outcome measuresPreoperatively, we evaluated whether the transition to TP biopsy was associated with differences in postoperative treatment failure defined as a neoplasm-positive postoperative biopsy. Postoperative biopsies were compared with respect to their ability to sample the remnant tissue, specifically percentage of cores positive for prostate tissue.ResultsPreoperatively, 9/60 (15%) positive postoperative biopsies occurred in the TR group and 6/60 (10%) in the TP group; Kaplan-Meier survival estimates did not differ between groups (p=0.69 by log rank). Postoperatively, the numbers of cores positive for prostate tissue were 99/160 (62%), 63/107 (59%), and 36/39 (92%) in the TR biopsy, TP with ultrasound, and TP with mUS groups, respectively; this difference was statistically significant versus the rate in the TR and standard TP groups (p=0.0003 and 0.0002).ConclusionWe found no significant improvement in patient screening, preoperatively—though limited by small sample size and relatively short follow-up. The incorporation of high-frequency mUS for postoperative biopsies improved the ability to sample the remnant tissue with a higher efficiency.
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Affiliation(s)
- Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael A. Gorin
- Urology, Urology Associates and UPMC Western Maryland, Cumberland, Maryland, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Akshay Sood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Phil Olson
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Guillaume Farah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Renee Hanna Cole
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
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Tzeng M, Basourakos SP, Patel HD, Allaway MJ, Hu JC, Gorin MA. Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System. BJUI COMPASS 2022; 3:434-442. [PMID: 36267202 PMCID: PMC9579885 DOI: 10.1002/bco2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To report the results of a pooled analysis evaluating the cancer detection rates, complications, and tolerability of prostate biopsies performed using the PrecisionPoint Transperineal Access System. Patients and Methods The medical literature was reviewed to identify studies published prior to 1 October 2021 evaluating the PrecisionPoint device for performance of transperineal prostate biopsy. Pooled analyses were performed to assess overall and clinically significant cancer detection rates. Additionally, data on complications as well as patient tolerability of the procedure when performed under local anaesthesia were extracted. Results Transperineal biopsy with the PrecisionPoint Transperineal Access System achieved overall and clinically significant cancer detection rates of 67.9% and 42.6%, respectively. Among patients with Prostate Imaging Reporting and Data System 3, 4, and 5 lesions on prostate magnetic resonance imaging, clinically significant disease was found in 31.7%, 55.7%, and 71.8% of patients, respectively. Complications were rare, with sepsis reported in 4 (0.1%) of 3411 procedures despite frequent omission of antibiotic prophylaxis. Patients reported acceptable tolerability of the procedure when performed under local anaesthesia. Conclusions Within the available medical literature, there is uniform evidence supporting the use of the PrecisionPoint Transperineal Access System for performing prostate biopsy procedures. The reported cancer detection and infectious complication rates with this device are in line with other methods for performing transperineal prostate biopsy. A unique aspect of the PrecisionPoint device is its ability to facilitate performing transperineal prostate biopsy under local anaesthesia. This factor will likely lead to increased adoption of the beneficial transperineal approach to prostate biopsy.
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Affiliation(s)
- Michael Tzeng
- Department of Urology Weill Cornell Medicine New York New York USA
| | | | - Hiten D. Patel
- Department of Urology Loyola University Medical Center Maywood Illinois USA
| | | | - Jim C. Hu
- Department of Urology Weill Cornell Medicine New York New York USA
| | - Michael A. Gorin
- Urology Associates and UPMC Western Maryland Cumberland Maryland USA
- Department of Urology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
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Sidana A, Blank F, Wang H, Patil N, George AK, Abbas H. Schema and cancer detection rates for transperineal prostate biopsy templates: a review. Ther Adv Urol 2022; 14:17562872221105019. [PMID: 35783921 PMCID: PMC9243579 DOI: 10.1177/17562872221105019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer (PCa) is the most common noncutaneous malignancy in men and is
the second leading cause of cancer mortality in men in the United States.
Current practice requires histopathological confirmation of cancer achieved
through biopsy for diagnosis. The transrectal approach for prostate biopsy has
been the standard for several decades. However, the risks and limitations of
transrectal biopsies have led to a recent resurgence of transperineal prostatic
biopsies. Recent studies have demonstrated the transperineal approach for
prostate biopsies to be effective, associated with minimal complications and
superior in several aspects to traditional transrectal biopsies. While sextant
and extended sextant templates are widely accepted templates for transrectal
biopsy, there are a diverse set of transperineal biopsy templates available for
use, without consensus on the optimal sampling strategy. We aim to critically
appraise the salient features of established transperineal biopsy templates.
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Affiliation(s)
- Abhinav Sidana
- Associate Professor of Surgery, Director of Urologic Oncology, Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Fernando Blank
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hannah Wang
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nilesh Patil
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Arvin K. George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Hasan Abbas
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Schmeusser B, Levin B, Lama D, Sidana A. Hundred years of transperineal prostate biopsy. Ther Adv Urol 2022; 14:17562872221100590. [PMID: 35620643 PMCID: PMC9128053 DOI: 10.1177/17562872221100590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
The earliest recorded efforts to biopsy prostate, in the early 20th century, were made through transperineal (TP) approach, with open perineal prostate biopsy (PBx) being considered the gold standard for prostate cancer (PCa) diagnosis in that era. Later, to minimize morbidity and increase diagnostic accuracy, several technical modifications and transrectal ultrasound (TRUS) assistance were incorporated. However, in the 1980s, the transrectal (TR) approach became the predominant PBx method following the introduction of TRUS-TR PBx with sextant sampling, providing a convenient and efficacious method for prostate sampling. With modernization of PCa diagnosis, a recent resurgence of the TP PBx has been observed, driven primarily by TR drawbacks of infectious complications and sampling limitations. TP PBx is rapidly emerging as the new PBx standard, being officially recommended as the initial approach for biopsy in Europe and is increasingly being conducted and studied in the United States. The modern era of TP PBx is based on the improvements in local anesthesia techniques, TP access systems, and robotic assistance. These modifications and advancements have improved the ease of use, patient comfort, and diagnostic outcomes with TP PBx. Herein, we present a history of the evolution of TP PBx spanning over 100 years and explore the basis of the technique that merits future utilization.
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Affiliation(s)
- Benjamin Schmeusser
- Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Brandon Levin
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel Lama
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Knaub RJ, Allaf ME, Gorin MA. Freehand Transperineal Prostate Biopsy with Three-Dimensional Ultrasound Organ-Based Tracking. J Endourol 2021; 35:S7-S16. [PMID: 34499547 DOI: 10.1089/end.2021.0569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Transperineal prostate biopsy carries a significantly lower risk of infectious complications compared with the transrectal approach. We provide a step-by-step description of our current procedural technique for performing transperineal prostate biopsy under local anesthesia. A key component of our technique is the use of a disposable, probe-mounted needle guide that minimizes the number punctures to the perineal skin and allows for continuous needle visualization throughout the procedure. We have paired this device with a novel fusion biopsy platform that utilizes three-dimensional transrectal ultrasound to enable targeting of suspicious lesions found prebiopsy MRI as well as allows for mapping of biopsy core locations for postprocedure review and use at the time of subsequent prostate biopsy or ablation procedures.
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Affiliation(s)
- Ross J Knaub
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, Maryland, USA.,Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Steinberg RS, Kipling L, Bens KCB, Patil D, Henry M, Mehta A, Filson C. Enhanced antibiotic prophylaxis and infection-related complications following prostate biopsy. World J Urol 2021; 39:3415-3422. [PMID: 33772321 PMCID: PMC8571806 DOI: 10.1007/s00345-021-03674-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Sepsis after prostate biopsy is a costly and potentially lethal complication. We sought to assess whether enhanced antibiotic prophylaxis regimens combining oral and parenteral antibiotics may decrease the risk of post-biopsy urinary tract infection and sepsis compared to regimens with only oral antibiotics. METHODS We identified men with commercial insurance who underwent prostate biopsy (2009-2015) with prophylactic antibiotic coverage. Our primary exposure of interest was antibiotic regimen: enhanced, oral-only, and parenteral-only. Post-biopsy outcomes of interest included urinary tract infections and sepsis/bacteremia after prostate biopsy. We used bivariate testing to assess associations between outcomes, exposures, and other covariates of interest. Multivariable regression was used to estimate adjusted odds of infectious outcomes based on antibiotic regimen. RESULTS We identified 163,831 men who underwent prostate biopsy. The proportion of men with infectious complications (5.5% in 2009 to 6.9% in 2015, p < 0.001) and sepsis (0.24% in 2009 to 0.30% in 2015, p = 0.327) increased over the timeframe of our analysis. Use of fluoroquinolones was associated with a decreased risk of infectious outcomes (5.8 vs 7.3% without, OR 0.83, 95% CI 0.79-0.88). Use of enhanced antibiotic regimens was associated with an increased risk of infectious outcomes (6.8 vs 5.7% oral, OR 1.23, 95% CI 1.16-1.31) and sepsis (0.34 vs 0.24% oral, OR 1.40, 95% CI 1.08-1.82) among our cohort. CONCLUSION We did not observe a significant reduction in infectious complications among men who received enhanced antibiotics regimens before prostate biopsy. This may be due to increased antibiotic resistance or unmeasured risk factors among those receiving enhanced regimens.
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Affiliation(s)
- Rebecca S Steinberg
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark Henry
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
- Winship Cancer Institute, Emory Healthcare, Atlanta, GA, USA.
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MRI-Targeted Prostate Biopsy Techniques: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:1263-1281. [PMID: 34259038 DOI: 10.2214/ajr.21.26154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prostate cancer is the second most common malignancy in men worldwide. Systematic transrectal prostate biopsy is commonly used to obtain tissue to establish the diagnosis. However, in recent years, MRI-targeted biopsy (based on an MRI examination performed prior to consideration of biopsy) has been shown to detect more clinically significant cancer and less clinically insignificant cancer compared to systematic biopsy. This approach of performing MRI prior to biopsy has become, or is becoming, a standard of practice in centers throughout the world. This growing use of an MRI-directed pathway is leading to performance of a larger volume of MRI-targeted prostate biopsies. The three common MRI-targeted biopsy techniques are cognitive biopsy, MRI-ultrasound software fusion biopsy, and MRI in-bore guided biopsy. These techniques for using MRI information at the time of biopsy can be performed via a transrectal or transperineal approach. This narrative review presents the three MRI-targeted biopsy techniques along with their advantages and shortcomings. Comparisons among the techniques are summarized based on the available evidence. Studies to date have provided heterogeneous results, and the preferred technique remains debated.
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