Abstract
MR imaging provides awareness for rectoprostatic hematomas as a complication in prostate biopsy. We evaluated the frequency and size of clinically silent bleeding after in-bore MRI-guided prostate biopsy according to documentation in MRI. From 2007 until 2020 in-bore MRI-guided prostate biopsy was performed in 283 consecutive patients with suspected prostate cancer. Interventional image documentation was reviewed for rectoprostatic hematomas and rectal blood collections in this retrospective observational single-center study. Correlation to patient characteristics was analyzed using a multivariable logistic regression model. 283 consecutive patients with a mean age of 66 ± 8 years were included. We diagnosed bleeding complications in 41 (14.5%) of the patients. Significant rectoprostatic hematomas were found in 24 patients. Intra-rectal blood collections were observed in 16 patients and one patient showed bleeding in the urinary bladder. The volume of rectoprostatic hematomas was determined with a median of 7.5 ml (range 2–40 ml, IQR 11.25). We found no correlation between the presence of a rectoprostatic hematoma and malignant findings, patient position in biopsy, number of cores, age, prostate volume nor PSA density (p > 0.05). Rectoprostatic hematomas and rectal blood collections are rare complications after in-bore MR-guided prostate biopsy. MR imaging provides benefits not only for lesion detection in prostate biopsy but also for the control of bleeding complications, which can be overlooked in standard TRUS biopsy. Their significance in pain, erectile dysfunction, and urinary retention remains to be investigated.
Highlights
Prostate biopsy has recently undergone rapid developments regarding technique and image guidance
The volume of rectoprostatic hematomas was determined with a median of 7.5 ml
In the patient group with rectoprostatic hematoma, 15 of 24 patients did not have any anticoagulation or antiplatelet therapy, 5 patients had continued antiplatelet therapy, one patient had an interruption of anticoagulation, in three patients there was no information available
Summary
Prostate biopsy has recently undergone rapid developments regarding technique and image guidance. The diagnosis of prostate cancer was based on ultrasound-guided systematic biopsies. The prerequisite for an optimal prostate biopsy strategy is high sensitivity in the detection of significant cancerous lesions combined with a low complication rate. MR-guided prostate biopsy provides high target accuracy and a high detection rate for clinically significant c ancer[2,6,7,8]. Safety assessments include the rate of complications and the possible need for sedation or general anesthesia These assessments are complex due to different approaches and different numbers of cores o btained[8]. In comparison to systematic TRUS biopsy, transrectal in-bore MR-guided targeted biopsy implies a considerably reduced number of cores obtained, and the rate of complications is reported to be lower[6,8,11]
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