Transperineal Template-guided Biopsy Research Articles

Comparison of initial and second opinion reads of multiparametric magnetic resonance imaging of the prostate for transperineal template-guided biopsies with MRI-Ultrasound fusion

PurposeTo investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists for the detection of significant cancer in transperineal fusion prostate biopsy. MethodsThe evaluated data included age, PSA (ng/ml), PSA density, Gleason score, digital rectal examination (DRE), prostate volume of 149 patients. Twenty-seven patients (18%) had no previous prostate biopsy, 114 patients (77%) had a previous negative biopsy, and 8 patients (5%) were on active surveillance. Using PI-RADS v2 scores for mpMRI a second report was performed by a specialist uroradiologist. In all cases a subsequent transperineal biopsy was performed with at least 2 cores per target and additional background systemic cores. Initial and second-opinion radiology reports were evaluated for detection of any cancer and Gleason score (GS) 7-10 cancer, including positive predictive value and negative (NPV) and compared by Fisher's exact test. ResultsAt transperineal biopsy, 51 % (76/149) of patients had a GS 6-10 prostate cancer (PCa), 27 % (40/149) of patients had a GS 3 + 3 PCa and 12 % (18/149) a GS 3 + 4 and 12 % (18/149) had a GS ≥4 + 3 PCa. Agreement between initial and second-opinion reads was observed in 57.7% (86/149; kappa value = 0.32). The detection of clinically significant cancers with second-opinion reads was significantly higher (0.61; 17/28) compared to initial reads (0.35; 17/49); P = 0.034. ConclusionsSecond reading of prostate mpMRIs by subspecialised uroradiologists significantly improved the positive predictive value for detection of clinically significant prostate cancer and showed a trend towards improved NPV for MRI-negative cases where biopsy could be safely avoided. Urologists should be aware that the experience of the reporter will affect the report when making decisions if and how to obtain biopsies. Reporter experience may help to reduce overcalling and avoid over-targeting of lesions.

Application of modified transperineal template-guided prostate biopsy in the diagnosis of prostate cancer

Objective To investigate the clinical value of modified transperineal template-guided prostate biopsy (mTTPB) in the detection of prostate cancer. Methods A total of 217 patients were enrolled in this study. All the patients were randomly divided into 2 groups. The control group (n=112) underwent transperineal template-guided prostate biopsy (TTPB) which was traditional transperineal template-guided 11-region biopsy. On the basis of the control group, the apex of prostate was divided into four areas for biopsy in the observation group (mTTPB). The positive rate of apex and the incidence of complications were analyzed. The prostatic specimens from the radical prostatectomy underwent whole mount sections examination. The prostate biopsy results were compared with the postoperative pathological results. Results The average age of the control group and the observation group were (68.5±7.9) years and (67.3±8.5) years, PSA were (31.2±18.9) ng/ml and (29.7±19.5) ng/ml, prostate volume were (44.6±15.2) ml and (41.3±17.3) ml, respectively. In the control group, the positive rates of prostate cancer in 1-10 region were 24.1% (27/112), 27.7%(31/112), 23.2% (26/112), 28.6% (32/112), 26.8% (30/112), 25.0% (28/112), 26.8% (30/112), 19.6% (22/112), 25.9% (29/112), 25.0% (28/112), respectively, with an average of 25.3%. In the observation group, the positive rates in 1-10 region were 27.6% (29/105), 28.6% (30/105), 22.9% (24/105), 26.7% (28/105), 25.7% (27/105), 24.8% (26/105), 27.6% (29/105), 21.9% (23/105), 27.6% (29/105), 26.7% (28/105), respectively, with an average of 26.0%. There was no statistical difference between the two groups (P=0.904). The positive rate of apical prostate cancer in the control group and observation group was 37.5% (42/112) and 44.8% (47/105), respectively, and there was no statistical difference between the two groups (P=0.277). Patients were grouped according to PSA>20 ng/ml and PSA≤20 ng/ml. When PSA>20 ng/ml, the positive rate of apex was 58.6% (34/58) and 56.6% (30/53) respectively in the control group and the observation group, and there was no statistical difference between the two groups (P=0.830). When PSA≤20 ng/ml, the positive rate of apex was 14.8% (8/54) in the control group and 32.7% (17/52) in the observation group, with statistically significant differences (P=0.030). Before radical prostatectomy, 12 cases (57.1%) in the control group and 19 cases (73.1%) in the observation group showed apical invasion by biopsy. Results of whole mount sections examination in the control group showed that there were 19 cases (90.5%) with apical invasion, which was statistically different from that before surgery (P=0.035). The results of whole mount sections examination in the observation group showed that there were 23 cases (88.5%) with apex invasion, which had no statistical difference compared with that before surgery (P=0.291). There were no significant differences in the incidence of hematuria, fever, urinary retention and perineal discomfort between the observation group and the control group (all P>0.05). Conclusions mTTPB can significantly improve the detection rate of apical prostate cancer without increasing the incidence of complications, especially for patients with PSA≤20 ng/ml. Hence is safe and efficacious. Key words: Prostatic neoplasms; Biopsy; Diagnosis

Comparative study of freehand and template-guided transperineal prostate biopsy in the detection rate of prostate cancer

Objective This retrospective study compared the detection rates of prostate cancer between freehand transperineal biopsy(FTPB) and template-guided transperineal biopsy(TTPB) in the patients with PSA levels<20 ng/ml. Methods From April 2017 to April 2019, 768 patients with PSA levels <20 ng/ml were included into this study. Of these patients, 406 underwent FTPB procedures and 362 underwent TTPB procedures. There were no significant differences of median age [66.00(61.00, 70.00)vs. 66.00(61.00, 71.25)years], height [170.00(165.00, 172.00)vs. 170(165.00, 173.00)cm], weight [70.00(63.88, 75.00)vs. 70.00(63.75, 75.00)kg], BMI [24.22(22.22, 25.95)vs. 24.22(22.49, 25.82)kg/m2], PSA [8.75(6.49, 12.40)vs. 8.69(6.49, 11.96)ng/ml], fPSA [1.18(0.33, 2.15)vs. 1.15(0.76, 1.88)ng/ml], prostate volume [39.79(25.55, 53.94)vs. 39.88(24.46, 55.11)ml] between two groups. Patients’ biopsy results were recorded, the differences of prostate cancer detection rates between these two groups were analyzed, specifically including the cancer with Gleason score≥7 and the anterior zone cancer. Results The total prostate cancer detection rates were 33.7%(137/406) and 39.0%(141/362, P=0.134) in FTPB group and TTPB group respectively, and the detection rates of cancer with Gleason score≥7 were 23.9%(97/406) and 32.0%(116/362, P=0.012) respectively. The detection rates of anterior zone prostate cancer were 15.5% (63/406) and 27.3% (99/362, P<0.001). Moreover, in the patients with PSA <10 ng/ml, the prostate cancer detection rates were 29.8%(74/248) and 36.2%(81/224, P=0.144) respectively, while the detection rates of cancer with Gleason score≥7 were 19.4%(48/248) and 29.9%(67/224, P=0.008) respectively. Conclusions There was no significant difference in the total prostate cancer detection rates between 12-core TTPB group and 20-core FTPB group in the patients with PSA <20 ng/ml, but for the detection rate of cancer with Gleason score≥7, TTPB group was significantly higher than FTPB group, especially in the patients with PSA<10 ng/ml. In addition, for anterior zone prostate cancer, the detection rate of TTPB group was also higher than FTPB group. Key words: Prostatic neoplasms; Diagnosis; Freehand biopsy; Template-guided biopsy; Transperineal

Patients with Persistently Elevated PSA and Negative Results of TRUS-Biopsy: Does 6-Month Treatment with Dutasteride can Indicate Candidates for Re-Biopsy. What is the Best of Saturation Schemes: Transrectal or Transperineal Approach?

To identify patients who actually need a re - biopsy, based on alterations in PSA readings after 6-month treatment with Dutasteride. We also sought to bring out the most beneficial re-biopsy scheme. We have reviewed the records of patients with persistently elevated PSA and at least one set of TRUS biopsies. Patients who were treated with alpha -blockers/Dutasteride combination were considered as the study group, while patients in control received alpha-blockers alone. Patients in both groups underwent re-biopsy 6 months later. The two protocols of re-biopsies were used at that time: 20-24 cores saturation transrectal (ST)) and ≥ 40 cores saturation transperineal template-guided (STT) biopsies. One hundred thirty-three patients were included in this study. In 86.7 % of the patients in the study group mean PSA decreased from 7.4 ± 2.69 to 4.037 ± 1.53 (p-0.001). The overall cancer detection rate was 29 % (n-39: 19 v/s 20, control and study groups, respectively). In the study group PSA decreased to 26.73 ± 11.26 % in patients with cancer, compared with 40.54 ± 13.3 % in patients without. It must be emphasized that STT-biopsies detected significantly more cancers (38.46 v/s 20.59 %, p- 0.005). Mean cores number got to 21 ± 2.45 and 45 ± 5.65 in ST and STT biopsies, respectively. Six-month treatment with Dutasteride decreases PSA readings in 86.7 % of the patients. A PSA decline of less than 40% (cutoff) should be considered as an indicator for re-biopsy. Transperineal template-guided biopsies had a higher cancer detection rate.

Transperineal template–guided prostate biopsy: 10 years experience in one center

Objective To assess the efficacy and safety of transperineal template-guided prostate biopsy. Methods From Dec, 2003 to Dec 2013, a total of 3007 patients (30-91 years old, mean age 69 years old) who met the inclusion criteria underwent 11 regions transrectal ultrasound guided transperineal template prostate biopsy. The inclusion criteria included prostate-specific antigen (PSA) level more than 4.0 μg/L, abnormal prostate gland finding on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 μg/L (range 0.2-100 μg/L). The patients distribution in different PSA level included 176 cases (PSA 0-4.0 μg/L), 1179 cases (PSA 4.1-10.0 μg/L), 975 cases (PSA 10.1-20.0 μg/L) and 677 cases (PSA 20.1-100.0 μg/L). The prostate cancer detection rate in different PSA, prostate biopsy adverse effects, and prostate cancer spatial distribution were analyzed. Results A mean of 19 cores (ranged from 11 to 44 cores) were obtained for each biopsy. And more cores were performed in larger prostates than in smaller ones. One to four cores was implemented in each region. Prostate cancer was detected in 1 067 of 3 007 patients (35.5%). The prostate cancer detection rate in groups with PSA 0-4.0 μg/L, 4.1-10.0 μg/L, 10.1-20.0 μg/L, and 20.1-100.0 μg/L groups was 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), and 70.0% (474/677) respectively. The mean positives rate in prostate apex was higher than in other region [46.7% (499/1067) vs. 52.0% (555/1067), P=0.014]. Regarding adverse effects, 47.0% (1413/3007) reported hematuria, 6.1% (183/3007) developed hemospermia, 1.9% (57/3007) needed short-term catheterization after biopsy due to acute urinary retention, one patient suffered septicemia. Conclusions Transrectal ultrasound guided transperineal template prostate biopsy is a safe and accurate technique. The current study suggests that the positive detective rate in apical region is much higher than that in other region by using this technique. Key words: Prostate cancer; Biopsy; Transperineal; Template

Transperineal template-guided biopsy for diagnosis of prostate cancer in patients with at least two prior negative biopsies

To evaluate the prostate cancer (PCa) detection rate, PCa location, PCa significance and complications of a standardized 24-core template-guided transperineal biopsy (TPB) approach in patients with at least two negative transrectal biopsies. We prospectively recruited 50 men who had at least two negative transrectal ultrasound-guided extended biopsies in the past 24 months, a prostate-specific antigen (PSA) <20ng/mL, a prostate volume <100mL, and life expectancy of at least 90% at 10 years. All patients underwent a standardized 24-core template-guided TPB biopsy. The PCa detection rate, PCa location, PCa significance, and complications were recorded. Median age was 57.5 years and the median PSA level was 7.3ng/ml. PCa was detected in 24 patients (48%). The anterior zone was involved in 16 (32%) PCa. Six PCa (25%) were insignificant. Biopsy related complications occurred in 2 patients (4%). A 24-core TPB is a safe procedure with a high PCa detection rate. Few of the detected PCa are clinically insignificant. Men with at least two negative transrectal biopsies may be counseled to undergo TPB.

Transperineal template-guided prostate biopsy for patients with persistently elevated PSA and multiple prior negative biopsies

ObjectiveTo evaluate the use of transperineal template-guided prostate biopsy for patients with persistently elevated PSA despite multiple negative prior biopsies. Materials and methodsA retrospective review was performed of patients with at least two prior prostate biopsies who underwent transperineal template-guided biopsy. Electronic medical records were reviewed to obtain relevant clinical, laboratory, and pathologic data. ResultsA total of 34 patients underwent transperineal template-guided biopsy. Patients had a mean of 3.7 ± 1.6 (range 2–8) prior biopsies, including prior negative transurethral resection (TUR) biopsy in 6 (17.6%) patients. Prostate cancer was detected in 17 (50%) of the 34 patients. Of these, 14 (82.4%) patients had cancer in the anterior prostate, 9 (52.9%) patients had cancer in the apical prostate, and 16 (94.1%) patients had cancer in either the anterior or apical prostate. Gleason score was 3+3 in 9 (52.9%) patients and 3+4 or greater in 7 (47.1%) patients. The mean number of positive cores was 4.5 ± 3.0 (range 1–11). Of the 17 patients with a diagnosis of cancer, 7 underwent radical prostatectomy, 7 underwent radiation therapy, 1 elected active surveillance, and 1 was deciding between surgery and radiation therapy; 1 patient received palliative chemotherapy for synchronous metastatic pancreatic carcinoma. Patients in whom cancer was detected had significantly smaller prostate volume, higher PSA, higher PSA density, and greater PSA velocity. ConclusionsTransperineal template-guided prostate biopsy is an effective technique for detecting cancer in patients with persistently elevated PSA despite multiple negative biopsies. It improves sampling of the anterior and apical prostate, and should be included as part of the diagnostic algorithm to reduce extensive repeat biopsy.

2124 TRANSPERINEAL TEMPLATE-GUIDED PROSTATE BIOPSY FOR PERSISTENTLY ELEVATED PSA FOLLOWING MULTIPLE NEGATIVE BIOPSIES

INTRODUCTION AND OBJECTIVES: Patients with persistently elevated PSA despite multiple negative prostate biopsies pose a difficult clinical problem. We report our experience with the use of transperineal template-guided prostate biopsy for such patients. METHODS: A retrospective review was performed of patients with at least 2 negative prostate biopsies who underwent transperineal template-guided biopsy at the Massachusetts General Hospital. All patients underwent transperineal biopsy using a standard brachytherapy grid and transrectal ultrasound guidance under general anesthesia. Electronic medical records were reviewed to obtain relevant clinical, laboratory, and pathologic data. RESULTS: A total of 16 patients with a mean age of 64.6 4.4 years underwent transperineal template-guided prostate biopsy from 1/2009 through 9/2010. Mean number of prior biopsies per patient was 3.6 1.6 (range 2 – 7), including 5 (31.3%) patients who had prior negative TUR biopsy. Mean PSA, prostate volume, PSA density, and PSA velocity were 23.8 16.1 ng/ml, 62.5 31.3 ml, 0.46 0.42 ng / ml2, and 3.7 3.3 ng/ml/yr, respectively. A mean of 22.8 8.5 cores were obtained at biopsy. Prostate cancer was detected in 9 (56.3%) of the 16 patients. Of these, 8 (88.9%) patients had cancer in the anterior prostate. The distribution of Gleason score was as follows: 3 3 (n 4), 3 4 (n 2), 4 3 (n 1), 5 4 (n 1), focal 3 (n 1). Of the 9 patients with a diagnosis of cancer, 4 underwent radical prostatectomy, 1 elected active surveillance, 2 elected radiation therapy, and 2 were deciding therapy at the time of follow-up. Of the 7 patients with no cancer detected, 5 patients had no clinical change at a mean follow-up of 10.6 months and 2 patients were without follow-up data. One-way analysis of variance (ANOVA) was performed to compare variables between patients with and without detection of cancer (Table 1). Only prostate volume and PSA density were significantly different between the groups. CONCLUSIONS: Transperineal template-guided prostate biopsy is an effective technique for detecting cancer in patients with persistently elevated PSA despite multiple negative biopsies. This may result from improved sampling of the anterior prostate as suggested by the high proportion of such cancers in this series.

Beyond Diagnosis: Evolving Prostate Biopsy in the Era of Focal Therapy

Despite decades of use as the “gold standard” in the detection of prostate cancer, the optimal biopsy regimen is still not universally agreed upon. While important aspects such as the need for laterally placed biopsies and the importance of apical cancer are known, repeated studies have shown significant patients with cancer on subsequent biopsy when the original biopsy was negative and an ongoing suspicion of cancer remained. Attempts to maximise the effectiveness of repeat biopsies have given rise to the alternate approaches of saturation biopsy and the transperineal approach. Recent interest in focal treatment of prostate cancer has further highlighted the need for accurate detection of prostate cancer, and in response, the introduction of transperineal template-guided biopsy. While the saturation biopsy approach and the transperineal template approach increase the detection rate of cancer in men with a previous negative biopsy and appear to have acceptable morbidity, there is a lack of clinical trials evaluating the different biopsy strategies. This paper reviews the evolution of prostatic biopsy and current controversies.

Distribution of Cancer Foci Identified with Transperineal Template-guided Biopsies: Implications for Focal and Other Prostate Cancer Definitive Treatment

There has been increasing enthusiasm for focal definitive prostate cancer treatments in which only a portion of the gland receives ablative therapy. Additionally, other emerging options for definitive treatment have technical limitations that preclude treating the entire gland. In this study, we report detailed mapping of prostate cancer distribution in men undergoing transperineal template-guided mapping biopsy (TTMB) with implications for treatment planning and therapy selection.