V14-11 MRI/US FUSION GUIDED PROSTATE BIOPSY USING A TRANSPERINEAL APPROACH: STEP-BY-STEP INSTRUCTIVE VIDEO ABSTRACT

Abstract

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-11 MRI/US FUSION GUIDED PROSTATE BIOPSY USING A TRANSPERINEAL APPROACH: STEP-BY-STEP INSTRUCTIVE VIDEO ABSTRACT Eusebio Luna, Alberto Lopez-Prieto, Gloria Egui-Benatuil, Edward Gheiler, Ariel Kaufman, Dailianys Barrios, Farshad Shafizadeh, Michael Zachareas, and Fernando Bianco Eusebio LunaEusebio Luna More articles by this author , Alberto Lopez-PrietoAlberto Lopez-Prieto More articles by this author , Gloria Egui-BenatuilGloria Egui-Benatuil More articles by this author , Edward GheilerEdward Gheiler More articles by this author , Ariel KaufmanAriel Kaufman More articles by this author , Dailianys BarriosDailianys Barrios More articles by this author , Farshad ShafizadehFarshad Shafizadeh More articles by this author , Michael ZachareasMichael Zachareas More articles by this author , and Fernando BiancoFernando Bianco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric MRI has become an essential tool and is currently recommended by the AUA for the workup of men with suspected prostate cancer, the most common solid malignancy in the US.1-2 Office-based transrectal ultrasound prostate biopsies (TRUS) are still the standard in sampling the prostate.3 Notwithstanding its practicality, the transrectal approach harbors imprecision and a worse adverse events profile than a Transperienal approach.4 The perineum has been segregated to the operating room. However, we questioned this paradigm and develop a method to safely sample the prostate transperineally under local anesthesia in the office setting.5 Encouraging results led us to start an open-ended prospective registry NCT02381990 (clinicaltrials.gov), devised to evaluate outcomes of men treated with MRI/US- guided fusion in the office setting.6 Herein, we present a video-case showing a step-by-step execution of this technique. METHODS: This video shows a step-by-step transperineal MRI/US fusion guided prostate biopsy on a 75-year-old male with a PSA of 7.9 ng/ml and a PSA velocity > 1ng/ml/yr. He has no family history of prostate cancer and his digital rectal examination (DRE) was negative. An MRI was ordered and revealed several PI-RADS 3 regions of interest (ROI). The DICOM processing and incorporation into the fusion device was outsourced. On the procedure day, the fusion device was connected to the ultrasound and stepper with a grid. The biopsy was conducted as shown following the MRI plan. RESULTS: The procedure was performed successfully in 19 minutes. The patient reported a maximum pain of 3/10 and was discharged 20 minutes after its conclusion. He did not experience any adverse events. The biopsy was positive in one of the ROI. It was a Gleason 3+3 (GG1) prostate cancer in 50% of the core. Between 2014 and June 2020, we conducted 1,782 MRI/US Transperineal Biopsies under local anesthesia in the office setting at three different centers, a 91% (1,622) of these were MRI/US Fusion. Overall median biopsies time was 21 minutes (IQR 16,24). We abandoned transrectal biopsies in 2017. CONCLUSIONS: The purpose of this video is to show the tremendous benefits of such a feasible and convenient procedure. MRI/US fusion guided Prostate Biopsy using a Transperineal approach in an office-setting is reliable and reproducible. It deals with the “Harm” described by the US Task Force associated with prostate cancer screening, by thorough sampling in an office setting, providing accurate and precise information about the location of tumors to target, and opening a door for MRI/US-guided therapies in the office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1168-e1169 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eusebio Luna More articles by this author Alberto Lopez-Prieto More articles by this author Gloria Egui-Benatuil More articles by this author Edward Gheiler More articles by this author Ariel Kaufman More articles by this author Dailianys Barrios More articles by this author Farshad Shafizadeh More articles by this author Michael Zachareas More articles by this author Fernando Bianco More articles by this author Expand All Advertisement Loading ...