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Berridge C, Omer A, Lopez F, Bryant RJ, Lamb AD. Perspectives on technology - prostate cancer: is local anaesthetic transperineal prostate biopsy really better than transrectal biopsy? BJU Int 2024. [PMID: 38584582 DOI: 10.1111/bju.16349] [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: 04/09/2024]
Abstract
For many years, transrectal ultrasound-guided (TRUS) prostate biopsies have been performed to establish a histological diagnosis of prostate cancer. This has been the recommended standard of care procedure, but has always carried risks, in particular the risk of post-procedural sepsis, and the associated antibiotic burden and risk of development of antibiotic resistance. Transperineal (TP) prostate biopsies performed under local anaesthetic (LA) have been proposed as a possible solution to these issues, with potentially lower infectious complications, and avoidance of need for antibiotic prophylaxis. The European Association of Urology produced guidance in 2023 with 'weak' recommendations in favour of LATP biopsy as a new standard of care, citing its safety profile. Both the National Institute for Health and Care Excellence in the UK, and the American Urological Association in the United States, have concluded for now that the body of evidence is inadequate and not offered a similar recommendation. We discuss the available evidence, pros and cons of each technique, and the status of current trials in the field. We believe that clinical equipoise remains necessary, given the disparity in national and international guidelines highlighting the need for large randomised controlled trials to answer the question: is LATP biopsy really better than TRUS biopsy?
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Affiliation(s)
- Christopher Berridge
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Mukherjee S, Papadopoulos D, Chari N, Ellis D, Charitopoulos K, Charitopoulos I, Bishara S. High-grade prostate cancer demonstrates preferential growth in the cranio-caudal axis and provides discrimination of disease grade in an MRI parametric model. Br J Radiol 2024; 97:574-582. [PMID: 38276882 PMCID: PMC11027337 DOI: 10.1093/bjr/tqad066] [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: 07/12/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To determine if multiparametric MRI prostate cancer (PC) lesion dimensions in different axes could distinguish between PC, grade group (GG) >2, and GG >3 on targeted transperineal biopsy and create and validate a predictive model on a separate cohort. METHODS The maximum transverse, anterio-posterior, and cranio-caudal lesion dimensions were assessed against the presence of any cancer, GG >2, and GG >3 on biopsy by binary logistic regression. The optimum multivariate models were evaluated on a separate cohort. RESULTS One hundred and ninety-three lesions from 148 patients were evaluated. Increased lesion volume, Prostate Specific Antigen (PSA), Prostate Imaging Reporting and Data System score, and decreased Apparent Diffusion Coefficient (ADC) were associated with increased GG (P < .001). The ratio of cranio-caudal to anterior-posterior lesion dimension increased from 1.20 (95% CI, 1.14-1.25) for GG ≤ 3 to 1.43 (95% CI, 1.28-1.57) for GG > 3 (P = .0022). The cranio-caudal dimension of the lesion was the strongest predictor of GG >3 (P = .000, area under the receiver operator characteristic curve [AUC] = 0.81). The best multivariate models had an AUC of 0.84 for cancer, 0.88 for GG > 2, and 0.89 for GG > 3. These models were evaluated on a separate cohort of 40 patients with 61 lesions. They demonstrated an AUC, sensitivity, and specificity of 0.82, 82.3%, and 55.5%, respectively, for the detection of cancer. For GG > 2, the models achieved an AUC of 0.84, sensitivity of 91.7%, and specificity of 69.4%. Additionally, for GG > 3, the models showed an AUC of 0.92, sensitivity of 88.9%, and specificity of 98.1%. CONCLUSIONS Cranio-caudal lesion dimension when used in conjunction with other parameters can create a model superior to the Prostate Imaging Reporting and Data Systems score in predicting cancer. ADVANCES IN KNOWLEDGE Higher-grade PC has a propensity to grow in the cranio-caudal direction, and this could be factored into MRI-based predictive models of prostate biopsy grade.
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Affiliation(s)
- Subhabrata Mukherjee
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Dimitrios Papadopoulos
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Natasha Chari
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - David Ellis
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Konstantinos Charitopoulos
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Ivo Charitopoulos
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Samuel Bishara
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
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Theivendrampillai S, Yang B, Little M, Blick C. Targeted augmented reality-guided transperineal prostate biopsies study: initial experience. Ther Adv Urol 2024; 16:17562872241232582. [PMID: 38464882 PMCID: PMC10924555 DOI: 10.1177/17562872241232582] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Background Transperineal biopsy of magnetic resonance imaging (MRI)-detected prostate lesions is now the established technique used in prostate cancer (CaP) diagnostics. Virtual Surgery Intelligence (VSI) Holomedicine by Apoqlar (Hamburg, Germany) is a mixed reality (MR)/augmented reality (AR) software platform that runs on the HoloLens II system (Microsoft, Redford, USA). Multiparametric prostate MRI images were converted into 3D holograms and added into a MR space, enabling visualization of a 3D hologram and image-assisted prostate biopsy. Objective The Targeted Augmented Reality-GuidEd Transperineal (TARGET) study investigated the feasibility of performing AR-guided prostate biopsies in a MR framework, using the VSI platform in patients with MRI-detected prostate lesions. Methods Ten patients with a clinical suspicion of CaP on MRI (Prostate Imaging-Reporting and Data System, PI-RADS 4/5) were uploaded to the VSI HoloLens system. Two MR/AR-guided prostate biopsies were then acquired using the PrecisionPoint Freehand transperineal biopsy system. Cognitive fusion biopsies were performed as standard of care following the MR/AR-guided prostate biopsies. Results All 10 patients successfully underwent MR/AR-guided prostate biopsy after 3D MR images were overlaid on the patient's body. Prostatic tissue was obtained in all MR/AR-guided specimens. Seven patients (70%) had matching histology in both the standard and MR/AR-guided biopsies. The remaining three had ISUP (International Society of Urological Pathology) Grade 2 CaP. There were no immediate complications. Conclusion We believe this is a world first. The initial feasibility data from the TARGET study demonstrated that an MR/AR-guided prostate biopsy utilizing the VSI Holomedicine system is a viable option in CaP diagnostics. The next stage in development is to combine AR images with real-time needle insertion and to provide further data to formally appraise the sensitivity and specificity of the technique.
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Affiliation(s)
| | - Bob Yang
- Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Mark Little
- Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Christopher Blick
- Department of Urology, Royal Berkshire Hospital, Craven Road, Reading, Berkshire RG1 5AN, UK
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Lehner F, Crippa A, Sigg S, Eberli D, Mortezavi A. Transperineal template saturation and conventional biopsy for stage prediction in prostate cancer. BJU Int 2023; 132:696-704. [PMID: 37704215 DOI: 10.1111/bju.16181] [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] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To evaluate the performance of risk calculators (RCs) predicting lymph node invasion (LNI) and extraprostatic extension (EPE) in men undergoing transperineal magnetic resonance imaging/transrectal ultrasound (TRUS)-fusion template saturation biopsy (TTSB) and conventional systematic TRUS-guided biopsy (SB). PATIENTS AND METHODS The RCs were tested in a consecutive cohort of 645 men undergoing radical prostatectomy with extended pelvic LN dissection between 2005 and 2019. TTSB was performed in 230 (35.7%) and SB in 415 (64.3%) men. Risk of LNI and EPE was calculated using the available RCs. Discrimination, calibration, and clinical usefulness stratified by different biopsy techniques were assessed. RESULTS Lymph node invasion was observed in 23 (10%) and EPE in 73 (31.8%) of cases with TTSB and 53 (12.8%) and 158 (38%) with SB, respectively. RCs showed an excellent discrimination and acceptable calibration for prediction of LNI based on TTSB (area under the curve [AUC]/risk estimation: Memorial Sloan Kettering Cancer Center [MSKCC]-RC 0.79/-4%, Briganti (2012)-RC 0.82/-4%, Gandaglia-RC 0.81/+6%). These were comparable in SB (MSKCC-RC 0.78/+2%; Briganti (2012)-RC 0.77/-3%). Decision curve analysis (DCA) revealed a net benefit at threshold probabilities between 3% and 6% when TTSB was used. For prediction of EPE based on TTSB an inferior discrimination and variable calibration were observed (AUC/risk estimation: MSKCC-RC 0.71/+8% and Martini (2018)-RC 0.69/+2%) achieving a net benefit on DCA only at risk thresholds of >17%. Performance of RCs for prediction of LNI and EPE based on SB showed comparable results with a better performance in the DCA for LNI (risk thresholds 1-2%) and poorer performance for EPE (risk threshold >20%). This study is limited by its retrospective single-institution design. CONCLUSIONS The potentially more accurate grading ability of TTSB did not result in improved performance of preoperative RCs. Prediction tools for LNI proved clinical usefulness while RCs for EPE did not.
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Affiliation(s)
- Fabienne Lehner
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Silvan Sigg
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, University Hospital Basel, Basel, Switzerland
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Szempliński S, Kamecki H, Mokrzyś M, Zawadzki M, Zagożdżon B, Dębowska M, Sosnowski R, Poletajew S, Kryst P, Nyk Ł. Patient-reported pain associated with grid-based transperineal magnetic resonance imaging (MRI)/ultrasound (US) software fusion biopsy of the prostate under local anesthesia: a multicenter experience. Transl Androl Urol 2023; 12:1250-1258. [PMID: 37680225 PMCID: PMC10481192 DOI: 10.21037/tau-23-139] [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: 03/03/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background Biopsy by transperineal (TP) approach is recommended standard for prostate cancer (PC) diagnosis. To avoid pain, patients undergoing TP biopsy may be offered sedation or general anesthesia. Our aim was to investigate the degree of patient-reported pain for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy of the prostate being performed under local anesthesia (LA) and to study for possible factors associated with increased risk of significant pain (SP) in this setting. Methods In this retrospective observational study, we reviewed data of consecutive patients without a prior diagnosis of PC who underwent MRI/US software fusion biopsy of the prostate under LA with lidocaine at two centers between May 2020 and April 2022, and who reported their periprocedural pain on a Wong-Baker FACES Pain Rating Scale (0-10). We defined SP as reported pain score of 6-10. Patient and procedure characteristics together with SP were studied for interdependencies. Results A total of 299 patients were included. Median pain score was 2 (interquartile range: 2-4), with SP having been reported by 55 (18.4%) patients. Among patient characteristics, only age demonstrated association with SP [odds ratio (OR), per 10 years =0.53, 95% confidence interval (CI): 0.35-0.80, P=0.003] and patients aged 62 or above were significantly less likely to report SP (OR =0.33, 95% CI: 0.18-0.60, P<0.001). Conclusions Performing TP MRI/US fusion prostate biopsy under LA is associated with low rates of SP, with the risk being significantly lower in older men. The results of this study can serve as evidence resource for preprocedural counselling in patients especially concerned about the risk of pain.
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Affiliation(s)
- Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Marek Zawadzki
- Department of Urology, St. Anna Hospital, Piaseczno, Poland
| | - Bartłomiej Zagożdżon
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Małgorzata Dębowska
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Roman Sosnowski
- Department of Urology and Oncological Urology, Warmian-Masurian Cancer Center, Olsztyn, Poland
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Alnosayan H, Alharbi MA, Alharbi AH, Aloraini AS, Alfayyadh AM, Almansour M. Initial Outcomes of Freehand Transperineal Biopsies Regarding Diagnostic Value and Safety: An Early Experience at King Fahad Specialist Hospital, Buraydah, Saudi Arabia. Cureus 2023; 15:e39318. [PMID: 37351252 PMCID: PMC10282500 DOI: 10.7759/cureus.39318] [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] [Accepted: 05/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prostate cancer is a common type of cancer in Saudi Arabia with a high incidence rate. Trans-rectal ultrasound guided prostatic biopsy (TRUSBx) has been the standard diagnostic study for prostate cancer since a landmark study in 1989 which showed that it is better than digitally directed biopsy sampling of the prostate. As an alternative to TRUSBx, transperineal biopsies (TPBx) have gained popularity as they give a higher accuracy rate and avoid many complications. A new study has been conducted in Riyadh, Saudi Arabia to compare TRUSBx and TPBx showed that TPBx has a significantly higher detection rate of prostate cancer cases compared to TRUSBx (45.1% vs. 29.1%, p=0.003). The aim of this study is to determine the diagnostic value and safety of freehand transperineal prostate biopsy in patients with an elevated prostatic specific antigen (PSA) and/or abnormal digital rectal exam in King Fahad Specialist Hospital KFSH in Buraydah, Qassim region, Saudi Arabia. METHODS This is an observational retrospective study of all patients (n=39) who underwent transperineal biopsies at KFSH to assess the diagnostic value and safety of the procedure. RESULTS The mean age of the patients was 70.3 (SD 10.1) years. The most commonly found diagnosis was adenocarcinoma (61.5%), and incidence of complications was detected in (5.1%) of the patients. CONCLUSION We concluded that the freehand technique TPBx has a high accuracy rate in detecting prostatic cancer. However, the learning curve could be a limiting factor in implementing it. Increasing the number of biopsies could positively affect diagnostic accuracy, especially with our low complication rate in this procedure. A low number of biopsies in the older age group can give an accurate result with a low risk of complications. Although template-guided TPBx and robot-guided TPBx are better options, the freehand technique represents a cost-effective and time-saving alternative. However, more studies are needed to compare the outcome of such a technique.
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Affiliation(s)
- Hatim Alnosayan
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
| | - Mohannad A Alharbi
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
| | - Adel H Alharbi
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
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Eldred-Evans D, Connor MJ, Bertoncelli Tanaka M, Bass E, Reddy D, Walters U, Stroman L, Espinosa E, Das R, Khosla N, Tam H, Pegers E, Qazi H, Gordon S, Winkler M, Ahmed HU. The rapid assessment for prostate imaging and diagnosis (RAPID) prostate cancer diagnostic pathway. BJU Int 2023; 131:461-470. [PMID: 36134435 DOI: 10.1111/bju.15899] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report outcomes within the Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) diagnostic pathway, introduced to reduce patient and healthcare burdens and standardize delivery of pre-biopsy multiparametric magnetic resonance imaging (MRI) and transperineal biopsy. PATIENTS AND METHODS A total of 2130 patients from three centres who completed the RAPID pathway (3 April 2017 to 31 March 2020) were consecutively entered as a prospective registry. These patients were also compared to a pre-RAPID cohort of 2435 patients. Patients on the RAPID pathway with an MRI score 4 or 5 and those with PSA density ≥0.12 and an MRI score 3 were advised to undergo a biopsy. Primary outcomes were rates of biopsy and cancer detection. Secondary outcomes included comparison of transperineal biopsy techniques, patient acceptability and changes in time to diagnosis before and after the introduction of RAPID. RESULTS The median patient age and PSA level were 66 years and 6.6 ng/mL, respectively. Biopsy could be omitted in 43% of patients (920/2130). A further 7.9% of patients (168/2130) declined a recommendation for biopsy. The percentage of biopsies avoided among sites varied (45% vs 36% vs 51%; P < 0.001). In all, 30% (221/742) had a local anaesthetic (grid and stepper) transperineal biopsy. Clinically significant cancer detection (any Gleason score ≥3 + 4) was 26% (560/2130) and detection of Gleason score 3 + 3 alone constituted 5.8% (124/2130); detection of Gleason score 3 + 3 did not significantly vary among sites (P = 0.7). Among participants who received a transperineal targeted biopsy, there was no difference in cancer detection rates among local anaesthetic, sedation and general anaesthetic groups. In the 2435 patients from the pre-RAPID cohor, time to diagnosis was 32.1 days (95% confidence interval [CI] 29.3-34.9) compared to 15.9 days (95% CI 12.9-34.9) in the RAPID group. A total of 141 consecutive patient satisfaction surveys indicated a high satisfaction rate with the pathway; 50% indicated a preference for having all tests on a single day. CONCLUSIONS The RAPID prostate cancer diagnostic pathway allows 43% of men to avoid a biopsy while preserving good detection of clinically significant cancers and low detection of insignificant cancers, although there were some centre-level variations.
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Affiliation(s)
- David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Mariana Bertoncelli Tanaka
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Uma Walters
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Luke Stroman
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Raj Das
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nalin Khosla
- Epsom and St Helier University Hospitals, London, UK
| | - Henry Tam
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Hasan Qazi
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schmid FA, Lieger L, Saba K, Sigg S, Lehner F, Waisbrod S, Müller A, Sulser T, Eberli D, Mortezavi A. Therapy decisions after diagnosis of prostate cancer in men with negative prostate MRI. Prostate 2023; 83:56-63. [PMID: 36073730 PMCID: PMC10087805 DOI: 10.1002/pros.24435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND To investigate the clinical implications of magnetic resonance imaging (MRI) negative prostate cancer (PCa) in a cohort of men undergoing transperineal prostate biopsy. METHODS We included all men without prior diagnosis of PCa undergoing transperineal template saturation ± fusion-guided targeted biopsy of the prostate between November 2014 and March 2018. Before biopsy, all patients underwent MRI and biopsies were performed irrespective of imaging results. Baseline characteristics, imaging, biopsy results, and follow-up information were retrieved from the patient charts. Patients were classified as either MRI negative (Prostate Imaging Reporting and Data System [PIRADS] ≤ 2) or positive (PIRADS ≥ 3). ISUP grade group 1 was defined as clinically nonsignificant (nsPCa) and ≥2 as clinically significant PCa (csPCa). Primary outcome was the individual therapeutic decision after diagnosis of PCa stratified according to MRI visibility. Secondary outcomes were the sensitivity and specificity of MRI, and the urooncological outcomes after radical prostatectomy (RP). RESULTS From 515 patients undergoing prostate biopsy, 171 (33.2%) patients had a negative and 344 (66.8%) a positive MRI. Pathology review stratified for MRI negative and positive cases revealed nsPCa in 27 (15.8%) and 32 (9.3%) and csPCa in 26 (15.2%) and 194 (56.4%) of the patients, respectively. The rate of active treatment in the MRI negative was lower compared with the MRI positive cohort (12.3% vs. 53.2%; odd ratio [OR] = 0.12; p < 0.001). While men with negative MRI were more likely to undergo active surveillance (AS) than MRI positive patients (18.1% vs. 10.8%; OR = 1.84; p = 0.027), they rarely underwent RP (6.4% vs. 40.7%, OR = 0.10; p < 0.001). Logistic regression revealed that a negative MRI was independently protective for active treatment (OR = 0.32, p = 0.014). The specificity, sensitivity, negative, and positive predictive value of MRI for detection of csPCa were 49.2%, 88.2%, 56.4%, and 84.8%, respectively. The rate of adverse clinicopathological outcome features (pT3/4, ISUP ≥4, or prostate-specific antigen [PSA]-persistence) following RP was 4.7% for men with MRI negative compared to 17.4% for men with MRI positive PCa (OR = 3.1, p = 0.19). CONCLUSION Only few men with MRI negative PCa need active cancer treatment at the time of diagnosis, while the majority opts for AS. Omitting prostate biopsies and performing a follow-up MRI may be a safe alternative to reduce the number of unnecessary interventions.
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Affiliation(s)
- Florian A Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Lieger
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karim Saba
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvan Sigg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabienne Lehner
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sharon Waisbrod
- Department of Urology, Spital-Limmattal, Schlieren, Switzerland
| | | | - Tullio Sulser
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Basel, Basel, Switzerland
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10
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Noh TI, Shim JS, Kang SH, Cheon J, Kang SG. Diagnostic performance of transperineal prostate targeted biopsy alone according to the PI-RADS score based on bi-parametric magnetic resonance imaging. Front Oncol 2023; 13:1142022. [PMID: 37035173 PMCID: PMC10080665 DOI: 10.3389/fonc.2023.1142022] [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: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose To compare the diagnostic performance of transperineal targeted biopsy (TB) or systematic biopsy (SB) alone based on combined TB+SB and radical prostatectomy (RP) specimen for detecting prostate cancer (PCa) according to the prostate imaging reporting and data system (PI-RADS) score. Materials and methods This study included 1077 men who underwent transperineal bi-parametric (bp) magnetic resonance imaging (MRI)-ultrasound (US) fusion TB+SB (bpMRI-US FTSB) between April 2019 and March 2022. To compare the performance of each modality (TB, SB, and combined TB+SB) with the RP specimen (as the standard) for detecting PCa and clinically significant PCa (csPCa), receiver operating characteristic (ROC) curves were plotted. Results PCa was detected in 581 of 1077 men (53.9%) using bpMRI-US FTSB. CsPCa was detected in 383 of 1077 men (35.6%), 17 of 285 (6.0%) with PI-RADS 0 to 2, 35 of 277 (12.6%) with PI-RADS 3, 134 of 274 (48.9%) with PI-RADS 4, and 197 of 241 (81.7%) with PI-RADS 5, respectively. The additional diagnostic value of TB vs. SB compared to combined TB+SB for diagnosing csPCa were 4.3% vs. 3.2% (p=0.844), 20.4% vs 5.1% (p<0.001), and 20.3% vs. 0.7% (p<0.001) with PI-RADS 3, 4, and 5, respectively. TB alone showed no significant difference in diagnostic performance for csPCa with combined TB+SB based on RP specimens in patients with PI-RADS 5 (p=0.732). Conclusion A need for addition of SB to TB in patients with PI-RADS 3 and 4 lesions, however, TB alone may be performed without affecting the management of patients with PI-RADS 5.
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11
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Hsi RA, Dinh T, Greer M, Bensen C, Mitchell MA, Li AY, Stamm A, Henne M. Performance of multiparametric prostate magnetic resonance imaging validated by targeted and systematic transperineal biopsies. BJUI Compass 2022; 4:96-103. [PMID: 36569501 PMCID: PMC9766867 DOI: 10.1002/bco2.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/23/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To measure the performance of multiparametric (mp) magnetic resonance imaging (MRI) to identify intraprostatic tumour deposits using a systematic and targeted MR-guided transperineal prostate biopsy technique. Materials and Methods Patients underwent a combined systematic and targeted MR-guided transperineal biopsy procedure in the dorsal lithotomy position under general anaesthesia. Systematic biopsies were spaced 10 mm or less apart and additional biopsies targeted any Prostate Imaging-Reporting and Data System (PI-RADS) 3, 4 or 5 lesions identified on mpMRI. Cancer detection rates were calculated on a per patient and per lesion basis. Results A total of 125 patients underwent the biopsy procedure. The positive predictive value (PPV) of mpMRI per patient was 59% for any cancer and 49% for Gleason score (GS) ≥ 7 cancer. The negative predictive value (NPV) of mpMRI per patient was 67% for any cancer and 88% for GS ≥ 7 cancer. On a per lesion basis, the PPV of PI-RADS 3 lesions for any and GS ≥ 7 cancer was 24% and 10%. For PI-RADS 4 lesions it was 42% and 32%. For PI-RADS 5 lesions, it was 76% and 70%. MpMRI failed to identify GS ≥ 7 cancer found on systematic biopsy in 22% of patients. Conclusion Based on a combination of systematic and targeted transperineal prostate biopsies, mpMRI showed a high NPV and low PPV for GS ≥ 7 cancer on a per patient basis. The PPV of mpMRI on a per lesion basis increased with increasing PI-RADS score. However, there were a significant number of both false positive as well as false negative (mpMRI invisible) areas within the prostate that contained GS ≥ 7 cancer. Therefore, pathologic confirmation using both targeted and systematic mapping biopsy is necessary to accurately identify all intraprostatic tumour deposits.
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Affiliation(s)
- Richard A. Hsi
- Seattle Cancer Care Alliance PeninsulaPoulsboWashingtonUSA
| | | | | | | | | | - Amy Y. Li
- The Doctors ClinicSilverdaleWashingtonUSA
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12
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Panzone J, Byler T, Bratslavsky G, Goldberg H. Transrectal Ultrasound in Prostate Cancer: Current Utilization, Integration with mpMRI, HIFU and Other Emerging Applications. Cancer Manag Res 2022; 14:1209-1228. [PMID: 35345605 PMCID: PMC8957299 DOI: 10.2147/cmar.s265058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/13/2021] [Accepted: 03/14/2022] [Indexed: 01/11/2023] Open
Abstract
Transrectal ultrasound (TRUS) has been an invaluable tool in the assessment of prostate size, anatomy and aiding in prostate cancer (PCa) diagnosis for decades. Emerging techniques warrant an investigation into the efficacy of TRUS, how it compares to new techniques, and options to increase the accuracy of prostate cancer diagnosis. Currently, TRUS is used to guide both transrectal and transperineal biopsy approaches with similar cancer detection rates, but lower rates of infection have been reported with the transperineal approach, while lower rates of urinary retention are often reported with the transrectal approach. Multiparametric MRI has substantial benefits for prostate cancer diagnosis and triage such as lesion location, grading, and can be combined with TRUS to perform fusion biopsies targeting specific lesions. Micro-ultrasound generates higher resolution images that traditional ultrasound and has been shown effective at diagnosing PCa, giving it the potential to become a future standard of care. Finally, high-intensity focused ultrasound focal therapy administered via TRUS has been shown to offer safe and effective short-term oncological control for localized disease with low morbidity, and the precise nature makes it a viable option for salvage and repeat therapy.
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Affiliation(s)
- John Panzone
- Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Timothy Byler
- Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Hanan Goldberg
- Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA
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13
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Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H. Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible. ANZ J Surg 2022; 92:1480-1485. [PMID: 35274426 PMCID: PMC9314011 DOI: 10.1111/ans.17593] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transperineal biopsy (TPB) of the prostate has been increasingly utilized as it has reduced infection risks. Traditionally however, it is performed under general anaesthesia, thus it carries a differing set of risks. Recently, new studies have performed TPB under local anaesthesia with success. In the present study, we explored our experience of performing TPB under local anaesthesia in an Australian cohort. METHODS In this prospective study based at a metropolitan outpatient clinic, patients were provided with TPB under local anaesthesia. We assessed prostate cancer detection rates, complication rates and patient tolerability. Pain tolerability was assess using patient reported pain score on the visual analogue scale. Follow up data was collected at days 7 and 30 post-biopsy via telephone interview. RESULTS A total of 48 patients were enrolled in this study between June 2020 and March 2021. Median age was 65.5 years and median PSA was 6.95 ng/mL. Clinically significant prostate cancer was detected in 58% of patients. During the procedure, pain scores were rated the highest during infiltration of local anaesthetic agent with a median score of 5. By the conclusion of the procedure, median pain score was 1. Vast majority of patients (85.4%) would opt for a repeat TPB under local anaesthesia should the need for prostate biopsy arise again. Two of our patients experienced infectious complications, and one experienced urinary retention. CONCLUSION Our data is in line with currently available data and confirms that TPB under local anaesthesia can be achieved in a safe and tolerable manner.
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Affiliation(s)
- Anne Hong
- Department of Urology, Austin Hospital, Melbourne, Victoria, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Hemmingway
- Faculty of Business, Law and Arts, Southern Cross University, Lismore, New South Wales, Australia
| | - David Wetherell
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Brendan Dias
- Department of Urology, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Homayoun Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Urology, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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14
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Abstract
PURPOSE OF REVIEW Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal approach as it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in transperineal prostate biopsy that may optimize the way biopsies are performed in clinical practice. RECENT FINDINGS Similarly, to transrectal biopsy, the transperineal approach also allows for the performance of systematic and MRI-targeted biopsy cores. As transperineal biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to transrectal biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, although transperineal biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for transperineal biopsy scaled nationally will likely result in significant healthcare savings. SUMMARY Transperineal biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional transrectal biopsy. Transperineal biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.
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Affiliation(s)
- Emily Cheng
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Meenakshi Davuluri
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Patrick J. Lewicki
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Jim C. Hu
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Spyridon P. Basourakos
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
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15
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El-Achkar A, Al-Mousawy M, Abou Heidar N, Moukaddem H, Hussein H, Mouallem N, El-Hajj A, Bulbul M. Magnetic resonance imaging /ultrasonography fusion transperineal prostate biopsy for prostate cancer: Initial experience at a Middle Eastern tertiary medical centre. Arab J Urol 2021; 19:454-459. [PMID: 34881061 PMCID: PMC8648043 DOI: 10.1080/2090598x.2021.1926727] [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: 12/15/2020] [Accepted: 02/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To report on the outcomes of magnetic resonance imaging (MRI)/ultrasonography (US)-fusion transperineal prostate (TP) biopsy at a tertiary medical centre in the Middle East including detection rate of clinically significant prostate cancer (csPCa), complications, and tolerability of the procedure. Patients and methods: Between May 2019 and June 2020, 98 MRI/US-fusion TP biopsies were performed in the US suite using light sedation. All patients had pre-biopsy 3-T multiparametric MRI. Data on patient characteristics, PCa detection rate and complication rates were collected retrospectively. A Gleason score ≥3 + 4 was defined as csPCa. RESULTS There were 98 patients, with a mean (SD) age of 65 (9.1) years, and a median (SD) prostate-specific antigen level prior to biopsy of 7.53 (12.97) ng/mL and prostate volume of 51 (31.1) mL. PCa was detected in 54 (55%) patients, with csPCa detected in 43 (44%). A total of 124 Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 lesions were targeted. Grade Group ≥2 PCa was found in 35.5% of the targeted lesions. Random biopsies detected one csPCa Gleason score 3 + 4 in one patient with a negative target. None of the patients had post-biopsy haematuria or retention. Only one patient developed acute prostatitis requiring in-patient intravenous antibiotics. CONCLUSIONS MRI/US-fusion TP biopsy has an adequate detection rate of csPCa with minimal complications and low infection rates after biopsy. This is one of the first TP biopsy series in the Middle East paving the way for wider adoption in the region. ABBREVIATIONS AS: active surveillance; AUR: acute urinary retention; GG: Grade Group; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; TP: transperineal; US: ultrasonography; TRUS: transrectal Ultrasound guided.
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Affiliation(s)
- Adnan El-Achkar
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Mouhammad Al-Mousawy
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Nassib Abou Heidar
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Hisham Moukaddem
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Hero Hussein
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Nadim Mouallem
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Albert El-Hajj
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Muhammad Bulbul
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
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16
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Yin H, Shao J, Song H, Ding W, Xu B, Cao H, Wang J. MRI Screening and MRI/US Fusion-Guided Transperineal Biopsy in Detecting Prostate Cancer. Technol Cancer Res Treat 2021; 20:15330338211019418. [PMID: 34013808 PMCID: PMC8142015 DOI: 10.1177/15330338211019418] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Systematic biopsy plays a vital role in diagnosing prostate cancer, but it can lead to misdiagnoses or undertreatment. Advances in magnetic resonance imaging (MRI) and its guided targeting technology provide the possibility of improving the use of biopsies. This study aimed to evaluate the performance of MRI screening and MRI/ultrasound (MRI/US) fusion-guided transperineal biopsy in the detection of prostate cancer. METHODS We performed a retrospective study on patients with suspected prostate cancer in the Kunshan Hospital Affiliated with Jiangsu University from January 2017 to December 2019. All of the patients underwent MRI examinations, followed by a systematic biopsy (either alone or in combination with MRI/US fusion-guided targeted biopsy, based on MRI-visible lesions). We evaluated the diagnostic accuracy of MRI screening and compared biopsy methods by considering sensitivity, specificity, and area under the curve (AUC) values. RESULTS A total of 157 patients were enrolled, including 112 patients with MRI-visible lesions and 45 patients without MRI-visible lesions. The cancer detection rate (CDR) was higher in patients with MRI-visible lesions (P < 0.001); however, the serum prostate-specific antigen (PSA) indicators were similar (P > 0.05). The AUC of MRI was 0.63, which was superior to the AUC values of ultrasound (AUC = 0.55, P = 0.031) and digital rectal examination (AUC = 0.52, P = 0.041) for screening prostate cancer. Both overall CDR and clinically significant prostate cancer detection rates were improved if we combined systematic biopsy and MRI/US fusion-guided targeted biopsy procedures. CONCLUSION Overall, prior MRI screening may serve as a classifier for avoiding the overuse of biopsies. A combination of systematic and MRI/US fusion-guided targeted biopsy procedures offers an optimal regimen for detecting prostate cancer.
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Affiliation(s)
- Hongqing Yin
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Jun Shao
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wei Ding
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Bin Xu
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Hui Cao
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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17
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Moreira P, Grimble J, Iftimia N, Bay CP, Tuncali K, Park J, Tokuda J. In vivo evaluation of angulated needle-guide template for MRI-guided transperineal prostate biopsy. Med Phys 2021; 48:2553-2565. [PMID: 33651407 DOI: 10.1002/mp.14816] [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: 07/03/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-guided transperineal prostate biopsy has been practiced since the early 2000s. The technique often suffers from targeting error due to deviation of the needle as a result of physical interaction between the needle and inhomogeneous tissues. Existing needle guide devices, such as a grid template, do not allow choosing an alternative insertion path to mitigate the deviation because of their limited degree-of-freedom (DoF). This study evaluates how an angulated needle insertion path can reduce needle deviation and improve needle placement accuracy. METHODS We extended a robotic needle-guidance device (Smart Template) for in-bore MRI-guided transperineal prostate biopsy. The new Smart Template has a 4-DoF needle-guiding mechanism allowing a translational range of motion of 65 and 58 mm along the vertical and horizontal axis, and a needle rotational motion around the vertical and horizontal axis ± 30 ∘ and a vertical rotational range of - 30 ∘ , + 10 ∘ , respectively. We defined a path planning strategy, which chooses between straight and angulated insertion paths depending on the anatomical structures on the potential insertion path. We performed (a) a set of experiments to evaluate the device positioning accuracy outside the MR-bore, and (b) an in vivo experiment to evaluate the improvement of targeting accuracy combining straight and angulated insertions in animal models (swine, n = 3 ). RESULTS We analyzed 46 in vivo insertions using either straight or angulated insertions paths. The experiment showed that the proposed strategy of selecting straight or angulated insertions based on the subject's anatomy outperformed the conventional approach of just straight insertions in terms of targeting accuracy (2.4 mm [1.3-3.7] vs 3.9 mm [2.4-5.0] {Median IQR } ); p = 0.041 after the bias correction). CONCLUSION The in vivo experiment successfully demonstrated that an angulated needle insertion path could improve needle placement accuracy with a path planning strategy that takes account of the subject-specific anatomical structures.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - John Grimble
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Nicusor Iftimia
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Jesung Park
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
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18
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Abstract
Background: The recent plethora of reports of "free-hand" transperineal prostate biopsy (fTP-Bx) under local anesthesia (LA) demonstrate that many centers consider this technique to be a safer and possibly more accurate approach to prostate biopsy in the clinic setting. Materials and Methods: The literature was searched for fTP-Bx, and summary tables were compiled. Studies on the costs of postprostate biopsy sepsis were also researched. Results: The search found 11,999 cases of fTP-Bx under LA with and without sedation over 29 mutually exclusive studies. Pooled averages calculated for age, prostate-specific antigen (PSA), prostate volume, PSA density, and cores sampled were 67.3 years, 10.4 ng/mL, 47.7 mL, 0.24 ng/mL/cc, and 15.3 cores, respectively. Detection of overall prostate cancer (PCa) and clinically significant (Gleason score ≥7) prostate cancer (csPCa) averaged 45.5% (3796/8338) and 25.1% (1141/4541), respectively. After subgrouping the studies by biopsy technique, studies that used MRI/ultrasound fusion-targeted biopsy in some or all biopsy cases averaged an overall PCa and csPCa detection rate of 50.0% (741/1483) (p < 0.0001) and 42.8% (635/1483) (p < 0.0001), respectively. Visual analog scale pain ratings and procedure times averaged 3.17 and 13.1 minutes, respectively. Averages for complications of sepsis and acute urinary retention were 0.0% (0/7396) and 2.1% (120/5693), respectively. A total of 10.2% (1055/10,334) of cases received no antibiotic prophylaxis. If fTP-Bx under LA replaced transrectal prostate biopsy (TR-Bx) in the United States, the estimated annual savings would be $341,676,800-$752,540,000 through the virtual elimination of admissions for postbiopsy sepsis. Conclusions: Many centers around the world have adopted fTP-Bx because it virtually eliminates sepsis, may improve detection rates of csPCa and can be easily integrated into a normal clinic workflow using only LA. If all urologists in the United States abandoned TR-Bx for fTP-Bx, the potential savings in health care costs of complications would be significant.
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Affiliation(s)
- Richard J Szabo
- Department of Urology, Kaiser Permanente, Irvine, California, USA.,Department of Urology, Cinical Associate Professor, University of California, Irvine, Orange, California, USA.,Department of Urology, Volunteer Faculty, Veterans Administration Healthcare System, Long Beach, California, USA
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19
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Gnanapragasam VJ, Leonard K, Sut M, Ilie C, Ord J, Roux J, Prieto MCH, Warren A, Tamer P. Multicentre clinical evaluation of the safety and performance of a simple transperineal access system for prostate biopsies for suspected prostate cancer: The CAMbridge PROstate Biopsy DevicE (CamPROBE) study. J Clin Urol 2020; 13:364-370. [PMID: 33072331 PMCID: PMC7521793 DOI: 10.1177/2051415820932773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/20/2020] [Accepted: 05/16/2020] [Indexed: 01/26/2023]
Abstract
Objectives: To report the prospective multicentre clinical evaluation of a first-in-man disposable device, Cambridge Prostate Biopsy Device, to undertake local anaesthetic outpatient transperineal prostate biopsies. Material and methods: Disposable single-use Cambridge Prostate Biopsy devices were manufactured based on a previous prototype. The lead site developed a user training course and disseminated the method to other sites. The Cambridge Prostate Biopsy Device (CamPROBE) was offered as an alternative to transrectal ultrasound guided biopsy to men due for a biopsy as part of their clinical management. Data on safety (infections and device performance), clinical utility, patient reported experience, biopsy quality and cancer detection were collected. Procedure time and local anaesthetic use was recorded in the lead site. The study was funded by a United Kingdom National Institute for Health Research (NIHR) i4i product development award. Results: A total of 40 patients were recruited (median age 69 y) across six sites; five sites were new to the procedure. Overall, 19/40 were first prostate biopsies and 21/40 repeat procedures. Both image-targeted and systematic biopsy cores taken. There were no infections, device deficiencies or safety issues reported. The procedure was well tolerated with excellent patient-reported perception and low pain scores (median of 3, scale 0–10). Histopathology quality was good and the overall cancer diagnosis rate (first diagnostic procedures) was 68% (13/19) and for significant cancers (⩾ histological Grade Group 2), 47% (9/19). In the lead centre (most experienced), median procedure time was 25 minutes, and median local anaesthetic use 11 ml (n=17). Conclusions: Data from this device evaluation study demonstrate that the United Kingdom-developed Cambridge Prostate Biopsy Device/method for transperineal biopsies is safe, transferable and maintains high diagnostic yields. The procedure is well tolerated by patients, suited to the local anaesthetic outpatient setting and could directly replace transrectal ultrasound guided biopsy. Level of evidence: Level III
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Affiliation(s)
- Vincent J Gnanapragasam
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.,Academic Urology Group, Department of Surgery, University of Cambridge, United Kingdom.,Department of Urology, Cambridge University Hospitals Trust, United Kingdom
| | - Kelly Leonard
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Michal Sut
- Department of Urology, North West Anglia NHS Trust, United Kingdom
| | - Cristian Ilie
- Department of Urology, The Queen Elizabeth Hospital Foundation Trust, United Kingdom
| | - Jonathan Ord
- Department of Urology, Cheltenham and Gloucester Hospital, United Kingdom
| | - Jacques Roux
- Department of Urology, West Hertfordshire Hospitals NHS Trust, United Kingdom
| | | | - Anne Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Priya Tamer
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
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20
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Thurtle D, Starling L, Leonard K, Stone T, Gnanapragasam VJ. Improving the safety and tolerability of local anaesthetic outpatient transperineal prostate biopsies: A pilot study of the CAMbridge PROstate Biopsy (CAMPROBE) method. J Clin Urol 2018; 11:192-199. [PMID: 29881622 PMCID: PMC5977271 DOI: 10.1177/2051415818762683] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/24/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to pilot the use of a bespoke device (CAMPROBE, the CAMbridge PROstate Biopsy) to enable routine outpatient free-hand local anaesthetic (LA) transperineal prostate biopsies. MATERIALS AND METHODS The CAMPROBE prototype was designed and built in our institution. Men on active surveillance due prostate resampling were invited to have a CAMPROBE biopsy as an alternative to repeat transrectal ultrasound-guided prostate biopsies (TRUSBx) as part of an approved trial (NCT02375035). Biopsies were performed using LA infiltration only, without sedation or additional analgesia. Patient-reported outcomes were recorded at day 0 and 7 using validated questionnaires and visual analogue scales (VAS). Complications were recorded prospectively. RESULTS Thirty men underwent biopsies with a median of 11 cores taken per procedure (interquartile range 10-12). There were no infections, sepsis or retention episodes. Haematuria and haematospermia occurred in 67% and 62% of patients, which are similar to rates reported for TRUSBx. Mean VAS for pain (0-10 scale) was less than 3 for every part of the procedure. All 30 men described the procedure as tolerable under LA. In total, 26/30 (86.7%) men expressed a preference for a CAMPROBE procedure over TRUSBx and a further 3 (10.0%) would have either. CONCLUSIONS In this small pilot study, the CAMPROBE device and method appears to be a safe, simple and well-tolerated out-patient transperineal replacement for TRUSBx. A major new National Institute for Health Research grant will allow its further development from a prototype to a single use, low-cost disposable device ready for multi-centre testing. LEVEL OF EVIDENCE 1b: individual cohort study.
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Affiliation(s)
- D Thurtle
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
| | - L Starling
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
| | - K Leonard
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
| | - T Stone
- Medical Physics and Clinical Engineering, Addenbrooke’s Hospital, Cambridge, UK
| | - VJ Gnanapragasam
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
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Hansen NL, Kesch C, Barrett T, Koo B, Radtke JP, Bonekamp D, Schlemmer HP, Warren AY, Wieczorek K, Hohenfellner M, Kastner C, Hadaschik B. 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; 120:631-638. [PMID: 27862869 DOI: 10.1111/bju.13711] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres. PATIENTS AND METHODS A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7-10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test. RESULTS The median (interquartile range) PSA level was 9.0 (6.7-13.4) ng/mL. PI-RADS 3-5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7-10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7-10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1-2 was 0.92 (±0.04) for Gleason score 7-10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7-10 cancers. In patients with suspicious lesions (PI-RADS 4-5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7-10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846. CONCLUSION In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7-10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.
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Affiliation(s)
- Nienke L Hansen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tristan Barrett
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Brendan Koo
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Jan P Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, DKFZ, Heidelberg, Germany
| | | | | | - Anne Y Warren
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Kathrin Wieczorek
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | | | - Christof Kastner
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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22
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Hansen NL, Barrett T, Koo B, Doble A, Gnanapragasam V, Warren A, Kastner C, Bratt O. The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in a repeat biopsy setting. BJU Int 2017; 119:724-730. [PMID: 27488931 DOI: 10.1111/bju.13619] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the influence of prostate-specific antigen density (PSAD) on positive (PPV) and negative (NPV) predictive values of multiparametric magnetic resonance imaging (mpMRI) to detect Gleason score ≥7 cancer in a repeat biopsy setting. PATIENTS AND METHODS Retrospective study of 514 men with previous prostate biopsy showing no or Gleason score 6 cancer. All had mpMRI, graded 1-5 on a Likert scale for cancer suspicion, and subsequent targeted and 24-core systematic image-fusion guided transperineal biopsy in 2013-2015. The NPVs and PPVs of mpMRIs for detecting Gleason score ≥7 cancer were calculated (±95% confidence intervals) for PSAD ≤0.1, 0.1-0.2, ≤0.2 and >0.2 ng/mL/mL, and compared by chi-square test for linear trend. RESULTS Gleason score ≥7 cancer was detected in 31% of the men. The NPV of Likert 1-2 mpMRI was 0.91 (±0.04) with a PSAD of ≤0.2 ng/mL/mL and 0.71 (±0.16) with a PSAD of >0.2 ng/mL/mL (P = 0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with a PSAD of ≤0.2 ng/mL/mL and 0.44 (±0.19) with a PSAD of >0.2 ng/mL/mL (P = 0.002). PSAD also significantly affected the PPV of Likert 4-5 mpMRI lesions: the PPV was 0.47 (±0.08) with a PSAD of ≤0.2 ng/mL/mL and 0.66 (±0.10) with a PSAD of >0.2 ng/mL/mL (P < 0.001). CONCLUSION In a repeat biopsy setting, a PSAD of ≤0.2 ng/mL/mL is associated with low detection of Gleason score ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with a high PSAD, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if the PSAD is low.
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Affiliation(s)
- Nienke L Hansen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Brendan Koo
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Andrew Doble
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Vincent Gnanapragasam
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Academic Urology Group, Department of Surgery and Oncology, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Anne Warren
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Christof Kastner
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ola Bratt
- CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Kato T, Komiya A, Morii A, Iida H, Ito T, Fuse H. Analysis of repeated 24-core saturation prostate biopsy: Inverse association between asymptomatic histological inflammation and prostate cancer detection. Oncol Lett 2016; 12:1132-1138. [PMID: 27446407 DOI: 10.3892/ol.2016.4693] [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: 02/09/2015] [Accepted: 04/05/2016] [Indexed: 11/06/2022] Open
Abstract
Saturation prostate biopsy protocols have been developed to improve the prostate cancer (PCa) detection rate, particularly in the setting of repeat biopsies. The present study attempted to clarify the association between PCa detection and various risk factors in repeat saturation biopsies. A retrospective analysis was conducted on 78 Japanese patients for whom findings had caused suspicion of PCa despite previous negative prostate biopsies, and who consecutively underwent a 24-core transperineal repeat biopsy at Toyama University Hospital (Toyama, Japan). PCa was confirmed histologically in 16 of the 78 patients (20.5%). A univariate analysis revealed that the prostate-specific antigen (PSA) level at repeat biopsy was higher (P<0.01), the fPSA/tPSA ratio was lower (P=0.04), the total prostate volume was smaller (P=0.01) and the PSA density was higher (P<0.01) in PCa patients than in patients with benign prostatic disease (BPD). Histological inflammation was more frequently observed in BPD patients than in PCa patients (P<0.01). A multivariate analysis revealed that histological inflammation was the only independent predictor of the presence of a malignant lesion on repeat biopsy (odds ratio, 0.027; P=0.01). It must be considered that inflammation may cause a PSA increase in some patients with a negative initial biopsy, leading to unnecessary repeat biopsy.
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Affiliation(s)
- Tomonori Kato
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Akira Komiya
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Akihiro Morii
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Hiroaki Iida
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Takatoshi Ito
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Hideki Fuse
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
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Muthuveloe D, Telford R, Viney R, Patel P. The detection and upgrade rates of prostate adenocarcinoma following transperineal template-guided prostate biopsy - a tertiary referral centre experience. Cent European J Urol 2016; 69:42-7. [PMID: 27123325 PMCID: PMC4846721 DOI: 10.5173/ceju.2016.675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/22/2015] [Revised: 07/29/2015] [Accepted: 11/22/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aim to present transperineal template-guided prostate biopsy (template biopsy) outcomes at a tertiary referral centre. Furthermore, to identify the detection rate of prostate cancer in those with a previous negative transrectal ultrasound guided prostate biopsy and the upgrade rate of those on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma. MATERIAL AND METHODS We conducted a prospective study of 200 consecutive men who underwent template biopsy over a 22-month period in a tertiary referral centre, using a standard 24 region template prostate biopsy technique. Indications and histology results, as well as complications, were recorded. RESULTS Median age was 67 years and median PSA was 10 ng/mL. Overall detection rate was 47%. 39.5% of cases with previous negative transrectal biopsies were found to have prostate adenocarcinoma. 47.5% of cases on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma were upgraded. The most frequent complication was acute urinary retention at a rate of 12.5%, however, the use of a single prophylactic dose of tamsulosin was found to be beneficial, with 13 cases needed to treat to prevent one episode. CONCLUSIONS Template biopsies are safe and efficacious with an overall detection rate of 47% in the present series. Due to the high detection rate, one must consider template biopsy following one negative transrectal biopsy where there is persistent clinical suspicion. Furthermore, those considering active surveillance for Gleason 3 + 3 = 6 disease should be offered template biopsy to confirm the grade of their disease.
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Affiliation(s)
- David Muthuveloe
- University of Birmingham, School of Cancer Sciences, United Kingdom
| | - Robert Telford
- University of Birmingham, School of Cancer Sciences, United Kingdom
| | - Richard Viney
- Queen Elizabeth Hospital, Department of Urology, Birmingham, United Kingdom
| | - Prashant Patel
- University of Birmingham, School of Cancer Sciences, United Kingdom
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25
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Sivaraman A, Sanchez-Salas R, Barret E, Ahallal Y, Rozet F, Galiano M, Prapotnich D, Cathelineau X. Transperineal template-guided mapping biopsy of the prostate. Int J Urol 2014; 22:146-51. [PMID: 25421717 DOI: 10.1111/iju.12660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 05/01/2014] [Accepted: 09/24/2014] [Indexed: 12/26/2022]
Abstract
Accurate diagnosis of prostate cancer has eluded clinicians for decades. With our current understanding of prostate cancer, urologists should devise and confidently present the available treatment options – active surveillance/radical treatment/focal therapy to these patients. The diagnostic modalities used for prostate cancer have the dual problem of false negativity and overdiagnosis. Various modifications in the prostate biopsy techniques have increased the accuracy of cancer detection, but we are still far from an ideal diagnostic technique. Transperineal template-guided mapping biopsy of the prostate is an exhaustive biopsy technique that has been improvised over the past decade, and has shown superior results to other available modalities. We have carried out a PubMed search on the available experiences on this diagnostic modality, and along with our own experiences, we present a brief review on transperineal template-guided mapping biopsy of the prostate.
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Affiliation(s)
- Arjun Sivaraman
- Department of Urology, Institute Mutualiste Monsouris, Paris, France
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26
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Grey ADR, Chana MS, Popert R, Wolfe K, Liyanage SH, Acher PL. Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting. BJU Int 2014; 115:728-35. [PMID: 25041307 DOI: 10.1111/bju.12862] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [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: 12/16/2022]
Abstract
OBJECTIVES To determine the sensitivity and specificity of multiparametric magnetic resonance imaging (mpMRI) for significant prostate cancer with transperineal sector biopsy (TPSB) as the reference standard. PATIENTS AND METHODS The study included consecutive patients who presented for TPSB between July 2012 and November 2013 after mpMRI (T2- and diffusion-weighted images, 1.5 Tesla scanner, 8-channel body coil). A specialist uro-radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system (PI-RADS) scores on a Likert-type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24-40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of Gleason pattern 4 or cancer core length ≥6 mm. RESULTS A total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer (n = 103); primary biopsy (n = 83); and active surveillance (n = 15). Patients' mean (±sd) age, prostate-specific antigen and prostate volumes were 65 (±7) years, 12.8 (±12.4) ng/mL and 62 (±36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI-RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [CI] 87-99) and a specificity of 60% (95% CI 51-68) at this threshold. Receiver-operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82-0.92). The negative predictive value of a PI-RADS score of ≤2 for clinically significant prostate cancer was 97.7% CONCLUSION We found that PI-RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision-making process for prostate biopsy.
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27
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Tilak G, Tuncali K, Song SE, Tokuda J, Olubiyi O, Fennessy F, Fedorov A, Penzkofer T, Tempany C, Hata N. 3T MR-guided in-bore transperineal prostate biopsy: A comparison of robotic and manual needle-guidance templates. J Magn Reson Imaging 2014; 42:63-71. [PMID: 25263213 DOI: 10.1002/jmri.24770] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 02/21/2014] [Accepted: 09/11/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To demonstrate the utility of a robotic needle-guidance template device as compared to a manual template for in-bore 3T transperineal magnetic resonance imaging (MRI)-guided prostate biopsy. MATERIALS AND METHODS This two-arm mixed retrospective-prospective study included 99 cases of targeted transperineal prostate biopsies. The biopsy needles were aimed at suspicious foci noted on multiparametric 3T MRI using manual template (historical control) as compared with a robotic template. The following data were obtained: the accuracy of average and closest needle placement to the focus, histologic yield, percentage of cancer volume in positive core samples, complication rate, and time to complete the procedure. RESULTS In all, 56 cases were performed using the manual template and 43 cases were performed using the robotic template. The mean accuracy of the best needle placement attempt was higher in the robotic group (2.39 mm) than the manual group (3.71 mm, P < 0.027). The mean core procedure time was shorter in the robotic (90.82 min) than the manual group (100.63 min, P < 0.030). Percentage of cancer volume in positive core samples was higher in the robotic group (P < 0.001). Cancer yields and complication rates were not statistically different between the two subgroups (P = 0.557 and P = 0.172, respectively). CONCLUSION The robotic needle-guidance template helps accurate placement of biopsy needles in MRI-guided core biopsy of prostate cancer.
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Affiliation(s)
- Gaurie Tilak
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sang-Eun Song
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Olutayo Olubiyi
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fiona Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tobias Penzkofer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Vyas L, Acher P, Kinsella J, Challacombe B, Chang RTM, Sturch P, Cahill D, Chandra A, Popert R. Indications, results and safety profile of transperineal sector biopsies (TPSB) of the prostate: a single centre experience of 634 cases. BJU Int 2014; 114:32-7. [PMID: 24053629 DOI: 10.1111/bju.12282] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population. PATIENTS AND METHODS A retrospective review of a single-centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24-38 cores using a 'sector plan'. Procedures were carried out under general anaesthetic in most patients. Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low-risk disease diagnosed based on a 12-core TRB (307). RESULTS Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors. As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL). Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment. Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per-urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis. CONCLUSIONS TPSB of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity.
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Affiliation(s)
- Lona Vyas
- The Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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29
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Grummet JP, Weerakoon M, Huang S, Lawrentschuk N, Frydenberg M, Moon DA, O'Reilly M, Murphy D. Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int 2014; 114:384-8. [DOI: 10.1111/bju.12536] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jeremy P. Grummet
- Alfred Health; Melbourne VIC Australia
- Epworth Healthcare; Melbourne VIC Australia
- Cabrini Health; Melbourne VIC Australia
- Monash University; Melbourne VIC Australia
| | | | | | - Nathan Lawrentschuk
- Epworth Healthcare; Melbourne VIC Australia
- Peter MacCallum Cancer Institute; Melbourne VIC Australia
| | - Mark Frydenberg
- Epworth Healthcare; Melbourne VIC Australia
- Cabrini Health; Melbourne VIC Australia
- Monash University; Melbourne VIC Australia
| | - Daniel A. Moon
- Epworth Healthcare; Melbourne VIC Australia
- Peter MacCallum Cancer Institute; Melbourne VIC Australia
- Cabrini Health; Melbourne VIC Australia
| | - Mary O'Reilly
- Cabrini Health; Melbourne VIC Australia
- Eastern Health Clinical School; Melbourne VIC Australia
- Monash University; Melbourne VIC Australia
| | - Declan Murphy
- Epworth Healthcare; Melbourne VIC Australia
- Peter MacCallum Cancer Institute; Melbourne VIC Australia
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