Monoprophylaxis With Cephalosporins for Transrectal Prostate Biopsy After the Fluoroquinolone-Era: A Multi-Institutional Comparison of Severe Infectious Complications

Value of MRI - T2 Mapping to Differentiate Clinically Significant Prostate Cancer

Standardized reporting of multiparametric prostate MRI (mpMRI) is widespread and follows international standards (Pi-RADS). However, quantitative measurements from mpMRI are not widely comparable. Although T2 mapping sequences can provide repeatable quantitative image measurements and extract reliable imaging biomarkers from mpMRI, they are often time-consuming. We therefore investigated the value of quantitative measurements on a highly accelerated T2 mapping sequence, in order to establish a threshold to differentiate benign from malignant lesions. For this purpose, we evaluated a novel, highly accelerated T2 mapping research sequence that enables high-resolution image acquisition with short acquisition times in everyday clinical practice. In this retrospective single-center study, we included 54 patients with clinically indicated MRI of the prostate and biopsy-confirmed carcinoma (n = 37) or exclusion of carcinoma (n = 17). All patients had received a standard of care biopsy of the prostate, results of which were used to confirm or exclude presence of malignant lesions. We used the linear mixed-effects model-fit by REML to determine the difference between mean values of cancerous tissue and healthy tissue. We found good differentiation between malignant lesions and normal appearing tissue in the peripheral zone based on the mean T2 value. Specifically, the mean T2 value for tissue without malignant lesions was (151.7 ms [95% CI: 146.9-156.5 ms] compared to 80.9 ms for malignant lesions [95% CI: 67.9-79.1 ms]; p < 0.001). Based on this assessment, a limit of 109.2 ms is suggested. Aditionally, a significant correlation was observed between T2 values of the peripheral zone and PI-RADS scores (p = 0.0194). However, no correlation was found between the Gleason Score and the T2 relaxation time. Using REML, we found a difference of -82.7 ms in mean values between cancerous tissue and healthy tissue. We established a cut-off-value of 109.2 ms to accurately differentiate between malignant and non-malignant prostate regions. The addition of T2 mapping sequences to routine imaging could benefit automated lesion detection and facilitate contrast-free multiparametric MRI of the prostate.

Transition from Transrectal to Transperineal MRI-Fusion Prostate Biopsy Does Not Comprise Detection Rates of Clinically Significant Prostate Cancer at a Tertiary Care Center

BACKGROUND

A remarkable paradigm shift has emerged regarding the preferred prostate biopsy approach, favoring the transperineal (TP) over the transrectal (TR) approach due to the reduced risk of severe urinary tract infections. However, its impact on the detection of clinically significant prostate cancer (csPCa) remains unclear.

MATERIALS AND METHODS

We relied on a prospectively maintained tertiary care database to identify patients who underwent either TP or TR prostate biopsy between 01/2014 and 12/2023. Of those, only patients with suspicious magnetic resonance imaging (MRI) PIRADS lesions (Likert-scale: 3,4,5) received MRI-targeted and systematic biopsies. Detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥ 2) were compared between biopsy approach (TP vs. TR) according to index lesion. Subsequently, uni- and multivariable logistic regression models were applied to investigate the predictive status of the biopsy approach within each subcohort.

RESULTS

Of 2063 patients, 1118 (54%) underwent combined MRI-guided and systematic prostate biopsy and were included in the final cohort. Of those, 127 (11%) and 991 (89%) underwent TP vs. TR. CsPCa rates, regardless of differences in patients' demographics and distribution of index PIRDAS lesions, did not differ statistically significantly and were 51 vs. 52%, respectively (p = 0.8). CsPCa detection rates for PIRDAS-3, PIRADS-4 and PIRADS-5 did not differ and were 24 vs. 23%, 48 vs. 51% and 72 vs. 76% for PIRADS-3, PIRADS-4 and PIRADS-5 subgroups for TP vs. TR, respectively (all p ≥ 0.9) Conclusions: The current results support the available data indicating that TP biopsy approach is comparable to transrectal biopsy approach regarding csPCa detection rates.

Comparative Retrospective Assessment of the Effectiveness and Risk Factors of Fluoroquinolones, Cephalosporines, and Selective Antibiotic Prophylaxis for Transrectal Prostate Biopsy

INTRODUCTION

Despite increasing resistance of enterobacteria against fluoroquinolones (FLU), they are still widely used during transrectal prostate biopsy (TRPB). This study was designed to analyse infectious complications and risk factors between FLU, cephalosporines (CEPH) and selective other antibiotics (O-AB) used during TRPB.

METHODS

664 patients were included retrospectively (152 FLU, 452 CEPH and 60 O-AB). Infectious complications were defined as fever >38.0°C, the in-house definition of complicated urinary tract infection (cUTI) (if all applied: fever >38.0°C, leucocytosis >11.000/µL and positive urine dipstick) or postinterventional bacteriuria. Hospitalisation rate, duration and comorbidities were also assessed. χ2 and Fisher's exact test were used for group comparison. Multivariate regression analysis assessed the association of comorbidities with infectious complications.

RESULTS

FLU and CEPH were indifferent regarding infectious complications, however in the O-AB group significantly more common compared to FLU and CEPH (11.6, 13.3, 25%, p < 0.05). Duration of hospital stay in CEPH was significantly shorter compared to FLU and O-AB (4.1 vs. 6.3 vs. 8.2 days, p < 0.05). Arterial hypertension showed increased association with fever (OR 6.002 (1.178; 30.597) p = 0.031) and cUTI (OR 6.006 (1.207; 29.891) p = 0.029).

CONCLUSION

Infectious complications were low and indifferent between FLU and CEPH but significantly more frequent in O-AB. Arterial hypertension was significantly associated with postinterventional fever and cUTI.

Comparison of a Personalized Prostate Biopsy Pattern With Traditional Transrectal Prostate Biopsy: Different Cancer Detection Rate

Background: In terms of prostate biopsy approaches, it is difficult to reach the ventral central region of the prostate with the traditional transrectal prostate biopsy, while with the transperineal biopsy, the tumor in the dorsolateral region of the prostate is easily missed. However, until now, no studies have investigated the biopsy accuracy in the selective application of transrectal or transperineal biopsies according to the lesion site.

Methods: We developed a personalized prostate biopsy pattern and the biopsy approach was selected individually according to the lesion site. We compared it with the traditional transrectal prostate biopsy method to evaluate the efficiency. Patients (n = 351) who underwent prostate biopsy at Qilu Hospital of Shandong University from January 2018 to October 2020 were divided into two groups, including the traditional transrectal prostate biopsy group (n = 236) and the personalized group (n = 115). The data from patients, including clinical characteristics, biopsy results, and complications, were analyzed.

Results: The clinical characteristics of the two groups were similar. The total detection rate of prostate cancer in the personalized group was 49.6%, which was significantly higher than 38.1% in the traditional group (p = 0.023). When prostate-specific antigen was &lt;20 ng/ml, the detection rates of the two groups were 30.4 and 19.3%, respectively (p = 0.039). The PI-RADS was positively associated with high-grade prostate cancer in the personalized group. Patients with complications in the traditional transrectal systematic method group accounted for 6.8%, and those in the personalized group complications through the transrectal and transperineal approaches accounted for 7.1 and 4.1%, respectively. The most common complications in the transrectal group were fever and rectal bleeding, and those in the transperineal group were hematuria and urinary retention.

Conclusion: Compared with traditional transrectal prostate biopsy, the personalized biopsy pattern improved the detection rate of prostate cancer. The complications of the transrectal approach were much higher than those in the transperineal approach.