Significant Cancer Detection Rates Research Articles

Clinically Significant Prostate Cancer Detection Following Transrectal and Transperineal Biopsy: Results of the Prostate Biopsy Efficacy and Complications Randomized Clinical Trial.

The comparative effectiveness of transrectal and transperineal prostate biopsy in detecting clinically significant prostate cancer is not well understood. We conducted a randomized clinical trial to determine whether transperineal biopsy improves the detection of clinically significant prostate cancer. Of the 840 men randomized, 93% were White, 44% had a previous biopsy, with a median age of 66 years and median PSA density of 0.14. Of these, 384 underwent transrectal and 398 underwent transperineal prostate biopsy. Prebiopsy prostate MRI was performed in 96% of men. Grade Group ≥ 2 prostate cancer was classified as clinically significant. Odds ratios were calculated using logistic regression to evaluate the effect of biopsy procedures on cancer detection rates. The detection rates of clinically significant prostate cancer were 47.1% and 43.2% (odds ratio 1.17; 95% CI, 0.88-1.55) for transrectal and transperineal biopsy, respectively. Age, PSA density, clinical stage and Prostate Imaging Reporting and Data System score were associated with the diagnosis of clinically significant cancer, whereas history of previous biopsy, anterior tumors, and biopsy procedure (transrectal or transperineal) were not. Clinically significant cancer detection rates in biopsy-naïve men undergoing MRI-targeted transrectal or transperineal biopsy were 59% and 62%, respectively. The overall cancer detection rates following transrectal and transperineal biopsy were 72.1% and 70.4%, respectively. There was no significant difference noted in the detection of clinically significant prostate cancer following transrectal or transperineal prostate biopsy. Urologists may utilize either biopsy procedure that best suits their patients' needs and practice setting.

P2 Evaluation of clinically significant cancer detection rate with MRI/US Fusion transperineal prostate biopsy in anterior prostate lesions

P2 Evaluation of clinically significant cancer detection rate with MRI/US Fusion transperineal prostate biopsy in anterior prostate lesions

Comparison of Diagnostic Performance of PI-RADS V2 and V2.1 and Interobserver Agreement in Both Versions

Objective: To compare the diagnostic performance for the detection of clinically significant prostate cancers and interobserver agreement between PI-RADS v2 and v2.1 Material and Method: The mpMRI images of 258 patients and 394 nodüles included in this retrospective study were obtained on 3T MR and evaluated by two radiologists according to PI-RADS v2 and v2.1. Sensitivity and specificity between v2 and v2.1 compared. Detection rates for clinically significant prostate cancers of upgraded and downgraded lesions in the use of v2.1 from v2 were assessed. Interobserver agreement was assessed using κ statistics. Results: PI-RADS v2.1 and v2 showed higher sensitivity and lower specificity (100%, 52.38%) in peripheral zone and showed higher sensitivity and specificity (92.86%, 98.79%) in transition zone for category ≥4 lesions in the detection of csPCa, not significantly difference was found between the two versions. Interobserver agreement was statistically significant and very weak in the transition zone (κ=0.383, κ=0.279, respectively), very strong in the peripheral zone (κ=0.869) according to both classifications and they were similar. Conclusion: The diagnostic performance of PI-RADS v2 and v2.1 were found similar in detecting clinically significant cancers and all cancers in both zones. The clinically significant cancer detection rate in category 2+1 lesions in the transition zone was higher than in category 2 lesions but it wasn’t statistically significant. Interobserver agreement was low in the transition zone and very strong in the peripheral zone in both versions.

Accuracy of MRI-ultrasound fusion-guided and systematic biopsy of the prostate.

Prostate multiparametric MRI (mpMRI) with subsequent targeted biopsy of suspicious lesions has a critical role in the diagnostic workup of prostate cancer. The objective was to evaluate the diagnostic accuracy of systematic biopsies, targeted biopsies, and the combination of both in prostate cancer detection. From January 1, 2013 to June 1, 2022, biopsy-naïve and prior biopsy-negative patients who underwent both systematic and targeted biopsies were included. MRIs were evaluated according to PI-RADS with biopsy threshold set at PI-RADS ≥3. Systematic biopsies consisted of 8-12 cores, based on prostate volume. Overall prostate cancer and clinically significant cancer (Gleason Score ≥3 + 4) detection rates were stratified based on PI-RADS and location within the prostate, and compared between biopsy types using McNemar test. Among 867 patients, 615 had prostate cancer, with 434 clinically significant cases. Overall detection rates were: PI-RADS 3 48%, PI-RADS 4 72%, and PI-RADS 5 90%. Detection rates for clinically significant cancer were 21%, 53%, and 72%, respectively. The combination of biopsy methods was most accurate in detecting clinically significant prostate cancer (P < .001). Targeted biopsies alone detected more clinically significant prostate cancer than systematic biopsies alone (43.1% vs 40.3%, P = .046). For posterior PI-RADS 5 lesions, no statistically significant difference was found between all biopsy methods. In the detection of clinically significant prostate cancer, the combination of systematic and targeted biopsies proves most effective. Targeted biopsies rarely missed significant cancer for posterior PI-RADS 5 lesions, suggesting systematic biopsies could be reserved for instances where targeted biopsy results are negative. This study emphasizes on the efficacy of mpMRI and targeted biopsies in suspected prostate cancer in real-world clinical context. For PI-RADS 5 lesions, systematic biopsies provide limited clinical benefit and may only be necessary when targeted biopsy results are negative.

Prioritizing precision: detection of prostate cancer using mri guided fusion needle biopsy across the pennsylvania urologic regional collaborative.

Targeted prostate biopsies are increasingly being performed by urologists in the United States including those in the Pennsylvania Urologic Regional Collaborative, a physician-led data-sharing and quality improvement collaborative. To evaluate the performance of MRI guided fusion needle prostate biopsies in the collaborative, we analyzed the variability by practice in rates of detection of clinically significant prostate cancer and patient characteristics associated with detection of clinically significant prostate cancer. We analyzed 857 first-time MRI fusion biopsy procedures performed at five practices (minimum 20 procedures) between 2015 and 2019. We used chi-square analysis for baseline patient characteristics and Grade Group (GG) ≥ 3 tumor detection rates by practice. Multivariable logistic regression was used to estimate the odds of clinically significant cancer detection when adjusting for baseline patient characteristics. Approximately 15% of men undergoing targeted MRI guided biopsy were ≤ 59 years old. Median prostate specific antigen (PSA) was 6.8 ng/ml. Detection rates for GG ≥ 3 tumors ranged from 14.3% to 28.3% (P = 0.02) across practices. However, the odds of GG ≥ 3 tumor detection did not differ significantly between practices after adjusting for clinical and radiographic factors. Overall, increased likelihood of detecting a GG ≥ 3 tumor was associated with increased age, DRE abnormalities, higher PSA, smaller gland volume and PI-RADS ≥ 4 MRI lesions. There was an 81% concordance rate between PI-RADS ≥ 4 and Gleason grade ≥ 3 prostate cancer. We demonstrate the value of obtaining pre-biopsy MRI given high concordance between presence of suspicious lesions and MRI-targeted biopsy detection of clinically significant prostate cancer. Variability of baseline patient characteristics among practices may account for the observed differences in clinically significant cancer detection rates. These findings can aid standardization and quality improvement efforts within the collaborative.

Prostagram magnetic resonance imaging in a screening population: Prostate Imaging-Reporting and Data System or Likert?

To compare biopsy recommendation rates and accuracy of the Prostate Imaging-Reporting and Data System, version 2 (PI-RADSv2) with the Likert scale for detection of clinically significant and insignificant prostate cancer in men screened within the Imperial Prostate 1 Prostate Cancer Screening Trial Using Imaging (IP1-PROSTAGRAM). Men aged 50-69 years were screened with Prostagram MRI. Scans were prospectively reported using both PI-RADSv2 (excluding dynamic contrast-enhanced sequence score) and 5-point Likert scores by expert uro-radiologists. Systematic and targeted transperineal biopsy was recommended if the scan was scored ≥ 3, based on either reporting system. The proportion of patients recommended for biopsy and detection rates for Grade Groups (GGs) 1 and ≥ 2 were compared. Receiver operating characteristic (ROC) analysis was performed to compare performance. A total of 406 men underwent Prostagram MRI. The median (interquartile range) age and prostate-specific antigen level were 57 (53-61) years and 0.91 (0.56-1.74) ng/mL, respectively. At MRI score ≥ 3, more patients were recommended for biopsy based on Likert criteria (94/406; 23%, 95% confidence interval [CI] 19.2%-27.6%) compared to PI-RADSv2 (72/406; 18%, 95% CI 14.2%-21.9%; P = 0.03). For MRI scores ≥ 4, PI-RADSv2 and Likert scales led to 43/406 (11%, 95% CI 7.9%-14.1%) and 35/406 (9%, 95% CI 6.2%-11.9%) men recommended for biopsy (P = 0.40). For GG ≥ 2 detection, PIRADSv2 and Likert detected 22% (95% CI 11.4%-30.8%, 14/72) and 16% (95% CI 9.5%-25.3%, 15/94), respectively (P = 0.56). For GG1 cancers detection these were 11% (95% CI 4.3%-19.6%, seven of 72) vs 11% (95% CI 4.7%-17.8%, nine of 94; P = 1.00). The accuracy of PI-RADSv2 and Likert scale was similar (area under the ROC curve 0.64 vs 0.65, P = 0.95). In reporting non-contrast-enhanced Prostagram MRI in a screening population, the PI-RADSv2 and Likert scoring systems were equally accurate; however, Likert scale use led to more men undergoing biopsy without a subsequent increase in significant cancer detection rates. To improve reporting of Prostagram MRI, either the PI-RADSv2 or a modified Likert scale or a standalone scoring system should be developed.

The Predictive Value of Prostate-Specific Antigen Density: A Retrospective Analysis of Likert 3 Multiparametric MRI of the Prostate.

Background Many international studies have covered the predictors of prostate cancer, but there is limited information pertaining to Likert 3 MRI scores and the diagnosis of clinically significant prostate cancer (cs-PCa). Therefore, this study aimed to assess the detection rate of significant prostate cancer in men with a Likert 3 score multiparametric MRI (mp-MRI) and the predictive value of prostate-specific antigen (PSA) density in detecting significant prostate cancer. Methods This is a retrospective analysis of patients referred for suspected confined prostate cancer. Inclusion criteria were patients with prostate mp-MRIscore of Likert 3 and a prostate biopsy performed. Exclusion criteria included grossly abnormal feeling prostate, no biopsy performed, and an mp-MRI score (Prostate Imaging-Reporting and Data System/Likert) of 1, 2, 4, and 5. cs-PCawas defined as ≥ Gleason 3+4 prostate cancer. PSA density (PSAD) was calculated from MRI estimation of prostate volume. PSAD and histology results were subjected to receiver operating characteristic (ROC) curve analysis with the intention to assess the detection rate of significant prostate cancer in men with Likert 3 mp-MRI and the predictive value of PSAD in detecting significant prostate cancer. Results A total of 819 eligible men had a pre-biopsy mp-MRI scan taken between October 2019 and March 2022. A total of 177 men (21.6%, n = 819) were Likert 3 positive, and 31 did not proceed to take prostate biopsies. A total of 146 patients were included in the study. The median PSAD was 0.19 in men with cs-PCa. Prostate cancer was detected in 42 men (28.8% of the total included set), of which 27 (18.5%) had a Gleason 3+3 prostate cancer and 15 (10.3%) had Gleason ≥ 3+4 prostate cancer. Therefore, 35.7% (n = 42) of biopsy-positive men with Likert 3 mp-MRI had cs-PCa. The ROC curve analysis confirms that PSAD is a predictor of cs-PCa. The optimal PSAD threshold was 0.16 (95% CI: 0.14-0.19), which gives an accuracy of 0.7371, a sensitivity of 0.7333, and a specificity of 0.7375. Conclusion The specificity of PSAD is arguably insufficient for it to stand alone as a decision-making tool when counseling men with equivocal mp-MRI on whether or not to undergo prostate biopsy. A predictive model will need to incorporate other independent risk factors.These may include lesion size, multiplicity, location of lesion(s), and age.

Complications of local anaesthetic transperineal ultrasound‐guided prostate biopsy: A systematic literature review

AbstractThe prostate cancer pathway has evolved rapidly over the last decade responding to evidence‐based recommendations. These changes were accelerated further over the last 5 years due to the Covid‐19 pandemic and the antibiotic stewardship policies regarding nosocomial/iatrogenic infections. Local anaesthetic transperineal ultrasound‐guided biopsy is a relatively new technique that became gold‐standard practice for prostate cancer diagnosis due to decreased sepsis rates. However, data that justified its implementation was more focused on its efficacy and clinically significant cancer detection rates, lacking robust methodological complications data, including in some cases the utilization of validated tools to assess complications. In patients subjected to local anaesthetic transperineal ultrasound‐guided prostate biopsies, what are the most recent reported complications? This systematic literature review followed Bettany‐Saltikov and McSherry's Manual guidance for systematic literature reviews. Patient/target, Intervention, Comparison, Outcome (PICO) research method, and Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) were used to structure the search strategy and report results. This review was conducted using PubMed/Medline, Excerpa Medica database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria focused on recent studies which matched current national and international prostate cancer pathway guidelines (National Institute for Health and Care Excellence and European Association of Urology). Quality assessments were performed using Critical Appraisal Skills Programme checklists. Four cohort studies were included in this review. A total of 946 men were submitted to local anaesthetic transperineal prostate biopsy. Patient experience showed procedure was tolerated with the most painful part of the procedure being local anaesthetic infiltration with Visual Analogue Score variation [2–5]. Few complications were reported. Haematuria had broad definitions across studies, being difficult to interpret the results of this complication. Only one case reported gross haematuria leading to acute urinary retention. Historically, acute urinary retention was mentioned as one of the main adverse effects of transperineal biopsies. However, in this systematic literature review it had similar incidence as transrectal biopsies, particularly when local anaesthesia was utilized. Lower urinary tract symptoms and erectile dysfunction seemed to not be affected by prostate biopsy procedures, however, more data is required as only two studies addressed these issues. Six urinary tract infection patients were reported (0.63%), and one urosepsis case (0.10%). This seems to demonstrate few urinary infections occur and fewer sepsis cases, particularly when compared with transrectal biopsies data, concurring with previous research. Marginal difference was noted between infection rates with or without antibiotic prophylaxis. Local anaesthetic transperineal ultrasound‐guided prostate biopsies seem to remain a safe procedure from a complications rate point of view. It has been proven before to have fewer urinary tract infections and sepsis episodes. Low‐risk patients can have LATPUS biopsies without antibiotic prophylaxis. High‐risk patients need clinician assessment and judicious utilization of antibiotics. Other complications require further studies with standardized biopsy techniques, clear complication definitions, and use of validated tools to measure complications.

Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes

To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy. All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥ 2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed. A total of 1,133 fusion biopsies performed by five providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5-46.9%, adjusted p-value = 0.575). Clinically significant cancer detection rates ranged from 11.1-16.7% in PI-RADS 3 (unadjusted p = 0.838), from 24.6-43.4% in PI-RADS 4 (adjusted p = 0.003), and from 69.4-78.8% in PI-RADS 5 (adjusted p = 0.766) lesions. There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.

PD38-06 WHAT IS THE IDEAL NUMBER OF CORES TO COLLECT PER REGION OF INTEREST DURING TARGETED PROSTATE BIOPSY?

You have accessJournal of UrologyCME1 Apr 2023PD38-06 WHAT IS THE IDEAL NUMBER OF CORES TO COLLECT PER REGION OF INTEREST DURING TARGETED PROSTATE BIOPSY? Casey Brodsky, Ji Qi, Kathryn Marchetti, and John Wei Casey BrodskyCasey Brodsky More articles by this author , Ji QiJi Qi More articles by this author , Kathryn MarchettiKathryn Marchetti More articles by this author , and John WeiJohn Wei More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past decade, magnetic resonance imaging (MRI)-guided targeted prostate biopsy has been gaining favor over 12-core systematic biopsy for more accurate detection of clinically significant prostate cancers; however, no guidelines exist regarding the optimal number of biopsy cores that should be taken per region of interest (ROI) identified on MRI. An ideal number of cores balances maximizing cancer detection while minimizing patient discomfort, procedure time, and infection risk. In this project, we analyze the prostate cancer detection rate depending on core number for a large patient cohort. METHODS: Patients receiving targeted prostate cancer biopsy at the University of Michigan between January 2017 and June 2022 were identified. For each biopsy, 12 systematic cores were taken, as well as 4 cores per ROI. Statistical simulation was performed in SAS, using 500 iterations randomizing the order of cores taken, to assess cancer detection rate (CDR) and clinically significant cancer detection rate (CSCDR, defined as Gleason grade group ≥2) if 1, 2, or 3 versus 4 cores were taken per ROI. Chi-square tests were used to compare CDR and CSCDR between different scenarios. RESULTS: We identified 1022 patients, with 1095 total ROIs biopsied. Median age at time of biopsy was 65 (IQR 60-71), and median pre-biopsy PSA was 6.7 ng/mL (IQR 4.9-9.5). On systematic 12-core biopsy, CDR and CSCDR were 60% and 31%, respectively. On targeted biopsy considering all 4 cores, CDR and CSCDR were 59% and 39%, respectively. Combined biopsy considering systematic 12-core plus 4-core targeted biopsy showed CDR and CSCDR of 70% and 44%, respectively. Compared to taking 4 cores per ROI, taking fewer than 4 cores resulted in a decrease in both CDR and CSCDR, with statistically significant decreases seen for 1 and 2 versus 4 cores (Figure 1). This effect is mitigated when both targeted and systematic biopsy were combined. CONCLUSIONS: These analyses indicate that relative to 4 cores per ROI, cancer detection was inferior when only 1 or 2 cores are taken, but that 3 cores was not clinically nor statistically different than 4 cores. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e995 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Casey Brodsky More articles by this author Ji Qi More articles by this author Kathryn Marchetti More articles by this author John Wei More articles by this author Expand All Advertisement PDF downloadLoading ...

New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles’ operation

ObjectivesCurrently, a prostate biopsy is guided by transrectal ultrasound (US) alone. However, this biopsy cannot be performed in men without an anus. The aim of this study was to show the outcomes of a new transperineal US (TPUS)-guided biopsy technique in patients who underwent Miles’ operation.MethodsBetween April 2009 and March 2022, TPUS-guided biopsy was consecutively conducted in 9 patients (median, 71 years; range, 61–78 years) with high prostate-specific antigen values (22.60 ng/mL; 6.19–69.7 ng/mL). Their anuses were all removed due to rectal cancer. TPUS-guided biopsy was performed according to information on prostate magnetic resonance imaging. The technical success rate, cancer detection rate, and complication rate were recorded. Tumor sizes were compared between benign and cancer groups using an unpaired t-test with Welch’s correction.ResultsThe new TPUS-guided biopsy was successfully performed in all patients. Cancer was detected in 77.8% (7/9) of the patients. These were all categorized as PI-RADS 5. Among them, the detection rate of significant cancer (Gleason score 7 or higher) was 66.7% (6/9). The median tumor size was 2.4 cm (1.7–3.1 cm). However, two patients were diagnosed with benign tissue with PI-RADS 3 or PI-RADS 4. Their median tumor size was 1.0 cm (0.8–1.2 cm). There was significant difference between the cancer and benign groups (p = 0.037) in terms of tumor size. Neither post-biopsy bleeding nor infections occurred.ConclusionsNew TPUS-guided biopsy technique may contribute to detecting large PI-RADS 5 prostate cancer in men after Miles’ operation.

Impact of changing PI-RADS cutoff on prostate cancer detection by MRI cognitive fusion biopsy in biopsy-naïve patients

BackgroundMulti-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3–5 and PI-RADS 4–5 as a threshold for targeted prostatic biopsy.MethodsThis is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3–4 versus PI-RADS 4–5 lesion by mpMRI for prostate cancer detection in biopsy-naive men.ResultsThe overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3–5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4–5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively).ConclusionsLimiting the TBs to PI-RADS 4–5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors.

Robot-Assisted Magnetic Resonance Imaging-Targeted versus Systematic Prostate Biopsy; Systematic Review and Meta-Analysis

Robot-assisted devices have been recently developed for use in prostate biopsy. However, it is possible advantages over standard biopsy remain unclear. We aimed to assess the diagnostic performance and safety of robot-assisted targeted (RA-TB) and systematic prostate biopsies (RA-SB). A systematic literature search was performed in MEDLINE and Scopus databases. The detailed search strategy is available at Prospero (CRD42021269290). The primary outcome was the clinically significant prostate cancer (PCa) detection rate. The secondary outcomes included the overall detection rate of PCa, cancer detection rate per core, and complications. The clinically significant cancer detection rate, overall cancer detection rate, and "per patient" did not significantly differ between RA-TB and RA-SB [OR = 1.02 (95% CI 0.83; 1.26), p = 0.05, I2 = 62% and OR = 0.95 (95% CI 0.78; 1.17), p = 0.17, I2 = 40%, respectively]. There were no differences in the clinically insignificant cancer detection rate "per patient" between RA-TB and RA-SB [OR = 0.81 (95% CI 0.54; 1.21), p = 0.31, I2 = 0%]. RA-TB had a significantly higher cancer detection rate "per core" [OR = 3.01 (95% CI 2.77; 3.27), p < 0.0001, I2 = 96%]. RA-TB and RA-SB are both technically feasible and have comparable clinical significance and overall PCa detection rates.

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

Safety and efficacy of software-assisted MRI-TRUS fusion-guided transperineal prostate biopsy in an outpatient setting using local anaesthesia.

To evaluate diagnostic accuracy, safety, and efficiency of an MRI-TRUS fusion-guided transperineal prostate biopsy method in an outpatient setting under local anaesthesia. Patients undergoing transperineal prostate biopsy were included from March 2021 to May 2022. Biopsies were performed under local anaesthesia in an outpatient setting, using specialised fusion software. Primary outcome was (clinically significant) cancer detection rate. Secondary outcomes were procedure time, patient discomfort during the procedure and complication rate. We included 203 male patients (69years +-SD 8.2) with PI-RADS score > 2. In total 223 suspicious lesions were targeted. Overall cancer detection rate and clinically significant cancer detection rate were 73.5% and 60.1%, respectively. (Clinically significant) cancer detection rates in PI-RADS 3, 4 and 5 lesions were 46.4% (23.2%), 78.5% (66.1%) and 93.5% (89.1%), respectively. Mean duration of the procedure including fusion, targeted and systematic biopsies was 22.5min. Patients rated injection of local anaesthesia on a numeric pain rating scale on average 3.7/10 (SD 2.09) and biopsy core sampling 1.6/10 (SD 1.65). No patient presented with acute urinary retention on follow-up consultation. Two (1%) patients presented with infectious complications. Four (2%) patients experienced a vasovagal reaction. Transperineal targeted biopsy with MRI-TRUS fusion software has high overall and clinically significant cancer detection rates. The method is well tolerated under local anaesthesia and in an outpatient setting.

Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System.

ObjectivesTo report the results of a pooled analysis evaluating the cancer detection rates, complications, and tolerability of prostate biopsies performed using the PrecisionPoint Transperineal Access System.Patients and MethodsThe medical literature was reviewed to identify studies published prior to 1 October 2021 evaluating the PrecisionPoint device for performance of transperineal prostate biopsy. Pooled analyses were performed to assess overall and clinically significant cancer detection rates. Additionally, data on complications as well as patient tolerability of the procedure when performed under local anaesthesia were extracted.ResultsTransperineal biopsy with the PrecisionPoint Transperineal Access System achieved overall and clinically significant cancer detection rates of 67.9% and 42.6%, respectively. Among patients with Prostate Imaging Reporting and Data System 3, 4, and 5 lesions on prostate magnetic resonance imaging, clinically significant disease was found in 31.7%, 55.7%, and 71.8% of patients, respectively. Complications were rare, with sepsis reported in 4 (0.1%) of 3411 procedures despite frequent omission of antibiotic prophylaxis. Patients reported acceptable tolerability of the procedure when performed under local anaesthesia.ConclusionsWithin the available medical literature, there is uniform evidence supporting the use of the PrecisionPoint Transperineal Access System for performing prostate biopsy procedures. The reported cancer detection and infectious complication rates with this device are in line with other methods for performing transperineal prostate biopsy. A unique aspect of the PrecisionPoint device is its ability to facilitate performing transperineal prostate biopsy under local anaesthesia. This factor will likely lead to increased adoption of the beneficial transperineal approach to prostate biopsy.

MP58-19 COMPARISON OF URONAV TRUS AND COGNITIVE FUSION TP BIOPSY IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP58-19 COMPARISON OF URONAV TRUS AND COGNITIVE FUSION TP BIOPSY IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER Amanda Sherman, Daneil Kuftinec, Lori Lyn Price, Alireza Moinzadeh, and William Faust Amanda ShermanAmanda Sherman More articles by this author , Daneil KuftinecDaneil Kuftinec More articles by this author , Lori Lyn PriceLori Lyn Price More articles by this author , Alireza MoinzadehAlireza Moinzadeh More articles by this author , and William FaustWilliam Faust More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal (TP) prostate biopsy is a safe and effective technique to sample the prostate gland with less risk of infection and bleeding. Targeting of abnormal lesions on MRI at time of biopsy can be performed with cognitive fusion or software-based platforms. The success of TP MRI-guided biopsy, particularly cognitive fusion, remains unclear. This study compares cancer detection rates between software-based transrectal US (TRUS)/MRI fusion biopsy and cognitive fusion TP prostate biopsy. METHODS: Biopsies (n=495) taken between 2019 and 2021 were performed using either TRUS with UroNav (TRUSUN) guidance, or via TP approach with cognitive fusion (TPCF) to target MRI lesion. Demographic characteristics, PSA, prostate volume, DRE status, highest PIRADS lesion on MRI and final biopsy pathology were collected. Cancer Detection Rate (CDR), clinically significant Cancer Detection Rate (csCDR), and clinically significant cancer detection rate in target only (csCDRt) were compared by technique type. Statistical analysis was performed using Chi-squared, Fisher's exact, and t-tests as appropriate. RESULTS: A total of 377 TRUSUN and 118 TPCF prostate biopsies were performed. TPCF detected more cancers of any grade (p=0.02), but there was no difference in csCDR or csCDRt. When stratified by lesion, there was no difference in cancer detection except in the PIRADS 5 group, where TPCF outperformed TRUSUN biopsy in detecting clinically significant prostate cancer (p=0.006). Further analysis of the PIRADS 5 group found no difference in baseline characteristics except for age (mean age 72.2y in TP group, 68.7y in TRUS p=0.008). CONCLUSIONS: TPCF prostate biopsy showed similar rates of csCDR and csCDRt as TRUSUN prostate biopsy. When analyzed by PI-RADS score, TPCF was found to have similar or, in the case of PI-RADS 5 lesion, superior csCDRt. Subgroup analysis did not find significant group differences, aside from age, to explain this finding. This data suggests that TPCF is as effective at detecting clinically significant prostate cancer as TRUSUN. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e999 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Sherman More articles by this author Daneil Kuftinec More articles by this author Lori Lyn Price More articles by this author Alireza Moinzadeh More articles by this author William Faust More articles by this author Expand All Advertisement PDF DownloadLoading ...

Diagnostic value of the abnormal digital rectal examination in the modern MRI-based prostate cancer diagnostic pathway.

Currently the National Institute for Health and Care Excellence (NICE) recommends an abnormal digital rectal examination (DRE) as a standalone referral criterion for suspected prostate cancer. Unlike referrals for a raised prostate-specific antigen (PSA) which are triaged directly to magnetic resonance imaging (MRI), an abnormal DRE requires re-examination in a secondary clinic first. Here, we investigated the ongoing value of the abnormal DRE as a referral criterion. This study is a retrospective review of patients referred to secondary care for suspected prostate cancer based on an abnormal DRE over a 15-month period at a single UK hospital (n = 158). Age, PSA, primary and repeat DRE findings and eventual diagnosis were collated. A concurrent raised PSA was present in 65/158 (41%). Concordance between primary and secondary care DRE was only 72/158 (46%). The overall and significant cancer detection rate was 26/158 (16%) and 22/158 (14%), respectively. Among men with a concurrent raised PSA, 19/65 (29%) had significant cancer found, whereas with an abnormal primary care DRE and normal PSA (n = 93), only 3/93 (3%) had a significant cancer. Mandating a PSA before referral for an abnormal DRE would have redirected 65/158 (41%) of men to MRI first, negating the need for a repeat DRE (p < 0.0001). This finding was recapitulated in a second prospective validation cohort (n = 30) with 9/30 (30%) redirected to MRI first. This is one of the first studies to investigate the value of the DRE in contemporary practice. We propose that PSA is used to triage men with an abnormal DRE to MRI without needing a repeat DRE. If the PSA is normal, the diagnostic yield is low but may still warrant a repeat DRE to assess the need for further investigations. Additional multicentre studies are required to further validate our findings. 4.

Individualised non-contrast MRI-based risk estimation and shared decision-making in men with a suspicion of prostate cancer: protocol for multicentre randomised controlled trial (multi-IMPROD V.2.0)

IntroductionEuropean Association of Urology and UK National Institute for Health and Care Excellence guidelines recommend that all men with suspicions of prostate cancer should undergo prebiopsy contrast enhanced, that is,...

Editorial Comment

In this study, Lavi et al sought to evaluate the performance of a novel biopsy processing technique to download tissue cores (SmartBx) in patients undergoing systematic transrectal ultrasound-guided biopsy. The authors found that longer cores and higher tissue yield per core were obtained with this system compared to the standard processing method. The purported advantage being a small, but significant overall cancer detection rate for PSA<10 and the ability to improve estimation of cancer location and volume.