Transperineal Fusion Research Articles

Do 5-Alpha Reductase Inhibitors Influence the Features of Suspicious Lesions on Magnetic Resonance Imaging and Targeted Biopsy Results for Prostate Cancer Diagnosis?

5-alpha reductase inhibitors (5-ARIs) change hormonal pathways and reduce prostate size. We evaluated the effects of 5-ARIs on prostatic multiparametric magnetic resonance imaging (mpMRI) suspicious findings and in the identification of prostate cancer using targeted biopsies. We conducted a retrospective study including 600 consecutive patients who, between 2017 and 2021, underwent combined transperineal fusion biopsies. Primary outcomes were Prostate Imaging Reporting and Data System version 2 (PIRADS v2) scores and the identification of clinically significant prostate cancer from suspicious lesions (targeted CSPC). Outcomes were compared between patients treated with 5-ARIs for a minimum of 6 months and the other patients. Patients treated with 5-ARIs were older (p < 0.001) with higher rates of previous prostate biopsies (p = 0.004). PIRADS scores were 3, 4, and 5 in 15 (29%), 28 (54%), and 9 (17%) patients among the 5-ARI group and 130 (24%), 308 (56%), and 110 (20%) patients among the others, and the scores were not different between the groups (p = 0.69). The targeted CSPC identification rate among 5-ARI patients was 31%, not different compared to the non-5-ARI group (p = 1). Rates of targeted CSPC for each PIRADS score were not affected by 5-ARI treatment. The 5-ARI was not associated with neither PIRADS ≥ 4 score nor targeted CSPC on logistic regression analyses (OR = 0.76, 95% CI 0.4-1.4 and OR = 1.02, 95% CI 0.5-1.9, respectively). 5-ARI treatment is not associated with PIRADS score alterations or targeted biopsy results. Patients treated by 5-ARIs with suspicious lesions should not be addressed differently during the mpMRI-related diagnostic process.

The learning curve for robotic-assisted transperineal MRI/US fusion-guided prostate biopsy

Transperineal fusion prostate biopsy has a considerable learning curve (LC). Robotic-assisted transperineal MRI/Ultrasound fusion-guided biopsy (RA-TP-FBx) may have an easier LC due to automatization. We aimed to assess the LC of RA-TP-FBx and analyze its most difficult steps. We prospectively analyzed cases randomized to a biopsy-naïve urology resident, the chief resident, and an expert urologist in RA-TP-FBx (controls). We also analyzed consecutive cases in the LC of the expert. The LC was defined by procedure time, PCa detection rate (including stratification by PI-RADS), entrustable professional activities (EPA) assessment scores, and the NASA task load index. We collectively performed 246 RA-TP-FBx with the Mona Lisa device. Procedure time for residents decreased steeply from maximum 53 min to minimum 10 min, while the mean procedure time for the expert was 9 min (range 17–5 min). PCa detection for PI-RADS-4 lesions was 57% for the naïve resident, 61% for the chief resident and 62% for the expert. There was also no difference in Pca detection for PI-RADS-4 lesions when comparing the first and second half of the experts’ biopsies (p = 0.8). Maximum EPA score was registered after 22 cases. Workload steeply declined. Proficient RA-TP-FBx performance appears feasible after 22 cases regardless of previous experience.

Difference in high-risk prostate cancer detection between transrectal and transperineal fusion approaches.

273 Background: Present study aimed to gain insight into whether patients with high-risk prostate cancer (defined as Gleason 8-10) are being more precisely diagnosed by MRI fusion technique compared to TRUS-guided biopsy. Methods: A special retrospective cohort study database analysis was planned and conducted by urological department of University clinic of Cologne. After the database cut off the group of 779 patients with prostate cancer that underwent biopsy and further surgical treatment (radical prostatectomy) was selected. it was split into 2 cohorts according to biopsy type: TRUS guided biopsy and transperineal Fusion Biopsy. Standard systemic approach included 12 cores in TRUS and 18 in MRI-guided cohorts. Additional 5-6 cores were taken from the region of interest in the Fusion group. All the patients during analysis were divided into risk groups: Gleason 6 (3+3) - low risk group, Gleason 7a (3+4) - intermediate risk group, favourable prognosis, Gleason 7b (4+3) - intermediate risk group, unfavourable prognosis, Gleason 8-10 – high group. Concordance of primary and postoperative pathology was estimated by using re-grading levels and migration from low\intermediate to high-risk group. Additionally, the presence of one or more risk factors (perineural and lymphovascular invasion, presence of cribriform pattern, etc.) in primary specimens was evaluated. Results: The groups were statistically equal by age (p = 0,16), PSA risk-groups (χ2= 1,36; p = 0,53), density division ( χ2= 0,58; p = 0,74), prostate volume (p = 0,23) and ECOG status (Me [25 %; 75 %] p = 0,17). There were no significant differences between groups in terms of final pathology – number of cases in low, intermediate and high risk groups (χ2= 1,37; p= 0,5). Difference was observed in lower rate of upgrading to high-risk group and higher detection of risk factors in favour of transperineal-targeted biopsy (Table). Exposure of targeted biopsy increased the probability of detecting high risk PCa by 39% compared to systemic cores (OR 1.39, 95% CI: 0.9 - 1.9; p = 0,06). Conclusions: Transperineal fusion biopsy can be characterised by a higher possibility of detecting high-risk prostate cancer compared to conventional transrectal methods. A higher probability of discovering risk factors after transperineal fusion biopsy might be an important tool for proper staging and risk-adapted treatment strategy.[Table: see text]

A Prospective Comparison of Transrectal Standard, Cognitive, Transperineal Fusion, and Mapping Prostate Biopsy for Cancer Detection.

Purpose: The aim of this research was to compare the clinically significant prostate cancer (csPCa) detection rate (International Society of Urological Pathology [ISUP] ≥2) for the four biopsy methods: transrectal ultrasound-guided biopsy (TRUS-GB), cognitive transrectal biopsy (COG-TB), fusion transperineal biopsy (FUS-TB), and transperineal template mapping biopsy (TPMB). Materials and Methods: The inclusion criteria were as follows: prostate-specific antigen (PSA) >2 ng/mL, and/or positive digital rectal examination (DRE), and/or suspicious lesion on transrectal ultrasound (TRUS) and Prostate Imaging Reporting and Data System (Pi-RADS) v2.1 ≥ 3 score. In total, 102 patients were enrolled in the study. Biopsies were performed by two urologists. In a single procedure, the first urologist performed a FUS-TB and TPMB followed by second urologist who performed TRUS-GB and COG-TB. All specimens were obtained within a single procedure. Results: The csPCa detection rate and overall cancer detection rate (CDR) per patient were comparable among the respective biopsy methods (p > 0.05). Compared with other biopsy methods, a lower clinically insignificant prostate cancer (cisPCa) was detected using COG-TB (p = 0.004). The positive cores percentage ratio (p < 0.001) as well as positive cores containing csPCa percentage ratio (p < 0.001) significantly increased for the targeted biopsy methods. The median maximum cancer core length (MCCL; p = 0.52) as well the median for the MCCL of csPCa (p = 0.47) did not differ significantly among the respective biopsy methods. Concordance of the Gleason scores between biopsy and postprostatectomy pathology did not differ significantly among biopsy methods (p = 0.87). For TRUS-GB, FUS-TB, and TPMB, the common predictive factors for csPCa were positive DRE, suspicious lesion on ultrasound and Pi-RADS 5. As for COG-TB, the only predictor was Pi-RADS 5. Conclusion: The targeted methods did not show an increase in detection of csPCa and overall CDR over systematic ones in patients with Pi-RADS ≥3. A lower cisPCa was detected using COG-TB in comparison with the other methods. The sampling efficiency increased for the targeted biopsy methods, which used only a proportion of positive cores and cores containing csPCa. There was no statistical difference in histology concordance among the biopsies. One common predictive factor of increased csPCa detection for all biopsy methods was Pi-RADS 5.

PD38-05 IS ROUTINE ANTIBIOTIC PROPHYLAXIS REQUIRED FOR TRANSPERINEAL PROSTATE BIOPSY?

You have accessJournal of UrologyCME1 Apr 2023PD38-05 IS ROUTINE ANTIBIOTIC PROPHYLAXIS REQUIRED FOR TRANSPERINEAL PROSTATE BIOPSY? Apoorv Dhir, Alexander Zhu, Ji Qi, Stephanie Ferrante, Kevin Ginsburg, Alice Semerjian, Craig Rogers, Amit Patel, Brian Stork, Arvin George, and For the Michigan Urological Surgery Improvement Collaborative Apoorv DhirApoorv Dhir More articles by this author , Alexander ZhuAlexander Zhu More articles by this author , Ji QiJi Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Craig RogersCraig Rogers More articles by this author , Amit PatelAmit Patel More articles by this author , Brian StorkBrian Stork More articles by this author , Arvin GeorgeArvin George More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy (TPBx) has successfully reduced the risk of infectious complications compared to the transrectal approach. Contemporary guidelines continue to recommend antibiotic prophylaxis due to potential rectal/skin flora contamination or entry into the urinary tract; however, this inherently risks escalating antimicrobial resistance. We sought to evaluate the current practice patterns of antibiotic prophylaxis (ATB) for TPBx and the associated rates of infectious complications. METHODS: Men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) prostate cancer registry who underwent non-fusion (systematic) TPBx between 2017 and 2022 were analyzed. Patient demographics, disease characteristics, and peri-procedural outcomes were assessed. The primary outcome was infectious complications after TPBx. Infections were defined as fever, sepsis, and/or UTI. RESULTS: We identified 2212 men who underwent non-fusion (systematic) TPBx in the study period, 669 (30%) of whom did not receive ATB for TPBx (Table 1). The yearly percentage of patients with no ATB rose from 0.81% in 2017 to 65.6% in 2022 (Figure 1). Between patients with ATB and no ATB, there were no statistically significant difference in rates of infection (0.65% vs 0.45%, p=0.77) or infectious hospitalizations (0.32% vs 0.45%, p=0.70). CONCLUSIONS: Use of antibiotic prophylaxis for TPBx has decreased over time in the state of Michigan. Antibiotic prophylaxis was not associated with rates of infection and infectious hospitalizations after transperineal fusion biopsy. Source of Funding: funding from Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e994 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Apoorv Dhir More articles by this author Alexander Zhu More articles by this author Ji Qi More articles by this author Stephanie Ferrante More articles by this author Kevin Ginsburg More articles by this author Alice Semerjian More articles by this author Craig Rogers More articles by this author Amit Patel More articles by this author Brian Stork More articles by this author Arvin George More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Промежностная фьюжн-биопсия предстательной железы. Диагностическая ценность в сравнении со стандартной биопсией.

Introduction. A significant improvement in the quality of prostate imaging by magnetic resonance (MRI), as well as the possibility of combining MRI and ultrasound images (fusion technology) for biopsy, open up new possibilities for the diagnosis of prostate cancer. The arsenal of methods of treating prostate cancer includes active surveillance and focal therapy for patients with low risk disease. That raises the question of improving the accuracy of diagnosis of tumor volume, stage and differentiation, which will largely determine the tactics of patient management. The aim of our work was to determine the diagnostic effectiveness of targeted MRI-assisted fusion biopsy of the prostate in comparison with standard biopsy. Materials and methods. We analyzed data of 356 patients who underwent tranperineal fusion biopsy. The age of the patients ranged from 48 to 72 years with an average value of 68.2 ± 2.1 years. The selection criteria for the study were an increase in the level of PSA (345 patients) – the range from 4 to 44.5 ng/ml (on average 6.02±0.21) or the detection of tumor-suspicious areas during finger rectal examination or transrectal ultrasound examination (TRUS) of the prostate gland (41 patients). Further methods of examination included multiparametric magnetic resonance imaging (MRI) and subsequent transperineal fusion biopsy in combination with standart biopsy. Results. In our study, the detection rate of prostate cancer was (82.6%) – the diagnosis was confirmed in 294 out of 356 examined patients. At the same time, with an increase in the PI-RADS gradation, the frequency of histological confirmation of cancer increased: 62.4% for PI-RADS 3 lesions, 89.6% for 4 and 96.7% for PI-RADS 5. Targeted biopsies confirmed the presence of prostate cancer in 246 cases out of 356 patients (69.1%). In relation to all cases of cancer detection, the proportion of positive targeted biopsies was 83.7%. Conclusion. Targeted MRI-assisted fusion biopsy allows detecting prostate cancer in 69.1%, but when supplemented with a polyfocal biopsy at standard points, the diagnostic accuracy increases to 82.6%. Thus, the data obtained allow us to conclude that based on the examination of patients with suspected prostate cancer using mpMRI with targeted fusion biopsy, supplemented by polyfocal biopsies at standard points, it is possible to determine the localization, extent and degree of malignancy of the tumor with a high degree of certainty.

Transrectal vs. transperineal fusion biopsy of the prostate : Time to switch to the perineal technique-comparison of methods and description of the transperineal procedure under local anesthesia

The clinical and histological diagnosis of prostate cancer is acrucial aspect of the routine work of aurologist. The high prevalence of multiresistant microorganisms leads to an increased incidence of sepsis after transrectal prostate biopsy. It requires a switch from the still gold-standard method to the transperineal fusion biopsy procedure after multiparametric prostate magnetic resonance imaging (MRI). This article provides an overview of the most important differences between the two methods and gives adetailed methodological description of transperineal fusion biopsy under local anesthesia.

Evaluation of the optimal strategy for prostate biopsy in men with a single unilateral lesion suspected of prostate cancer on multiparametric MRI undergoing transperineal fusion MRI-guided prostate biopsy

Evaluation of the optimal strategy for prostate biopsy in men with a single unilateral lesion suspected of prostate cancer on multiparametric MRI undergoing transperineal fusion MRI-guided prostate biopsy

Intraoperative 3D-US-mpMRI Elastic Fusion Imaging-Guided Robotic Radical Prostatectomy: A Pilot Study.

When performing a nerve-sparing (NS) robotic radical prostatectomy (RARP), cancer location based on multiparametric MRI (mpMRI) is essential, as well as the location of positive biopsy cores outside mpMRI targets. The aim of this pilot study was to assess the feasibility of intraoperative 3D-TRUS-mpMRI elastic fusion imaging to guide RARP and to evaluate its impact on the surgical strategy. We prospectively enrolled 11 patients with organ-confined mpMRI-visible prostate cancer (PCa), histologically confirmed at transperineal fusion biopsy using Koelis Trinity. Before surgery, the 3D model of the prostate generated at biopsy was updated, showing both mpMRI lesions and positive biopsy cores, and was displayed on the Da Vinci robotic console using TilePro™ function. Intraoperative 3D modeling was feasible in all patients (median of 6 min). The use of 3D models led to a major change in surgical strategy in six cases (54%), allowing bilateral instead of monolateral NS, or monolateral NS instead of non-NS, to be performed. At pathologic examination, no positive surgical margins (PSMs) were reported. Bilateral PCa presence was detected in one (9%), four (36%), and nine (81%) patients after mpMRI, biopsy, and RARP, respectively. Extracapsular extension was found in two patients (18%) even if it was not suspected at MRI. Intraoperative 3D-TRUS-mpMRI modeling with Koelis Trinity is feasible and reliable, helping the surgeon to maximize functional outcomes without increasing the risk of positive surgical margins. The location of positive biopsy cores must be registered in 3D models, given the rates of bilateral involvement not seen at mpMRI.

P028 - Comparison between transrectal and transperineal fusion guided prostate biopsy for the diagnosis of prostate cancer

P028 - Comparison between transrectal and transperineal fusion guided prostate biopsy for the diagnosis of prostate cancer

PROST-Net: A Deep Learning Approach to Support Real-Time Fusion in Prostate Biopsy

Prostate biopsy fusion systems employ manual segmentation of the prostate before the procedure, therefore the image registration is static. To pave the way for dynamic fusion, we introduce PROST-Net, a deep learning (DL) based method to segment the prostate in real-time. The algorithm works in three steps: firstly, it detects the presence of the prostate, secondly defines a region of interest around it, discharging other pixels of the image before the last step which is the segmentation. This approach reduces the amount of data to be processed during segmentation and allows to contour the prostate regardless of the image modality (e.g., magnetic resonance (MRI) or ultrasound (US)) and, in the case of US, regardless of the geometric disposition of the sensor array (e.g., linear or convex). PROST-Net produced a mean Dice similarity coefficient of 86&#x0025; in US images and 77&#x0025; in MRI images and outperformed other CNN-based techniques. PROST-Net is integrated in a robotic system&#x2013;PROST&#x2013; for trans-perineal fusion biopsy. The robot with PROST-Net gives the potential to track the prostate in real-time, thus reducing human errors during the biopsy procedure.

A comparative study of transperineal software-assisted magnetic resonance/ultrasound fusion biopsy and transrectal cognitive fusion biopsy of the prostate

BackgroundThe advantages and disadvantages of transperineal and transrectal biopsies remain controversial in the era of prostate targeted biopsy. In this study, we compared the cancer detection and complication rates of transperineal magnetic resonance/ultrasound (MR/US) fusion biopsy and transrectal cognitive fusion biopsy of the prostate.MethodsThis was a comparative study of two prospectively collected cohorts. Men with clinically suspected prostate cancer and prostate imaging reporting and data system (PI-RADS) score ≥ 3 lesions on multi-parametric magnetic resonance imaging (mpMRI) were enrolled. They underwent either transperineal software fusion biopsy or transrectal cognitive fusion biopsy and systematic biopsy. The detection rates of any prostate cancer and clinically significant prostate cancer (csPC, defined as Gleason score ≥ 3 + 4) and the complication rates between both groups were analysed.ResultsNinety-two and 85 patients underwent transperineal software fusion and transrectal cognitive fusion biopsies, respectively. The detection rate for any prostate cancer was similar between both groups (60.8% vs. 56.4%, p = 0.659). In terms of csPC detection, transperineal fusion biopsy outperformed transrectal fusion biopsy (52.2% vs. 36.5%, p = 0.036). In multivariate regression analysis, age, PI-RADS score > 3, and transperineal route were significant predictors of csPC. Meanwhile, transperineal biopsy resulted in a higher rate of urinary retention than transrectal biopsy (18.5% vs. 4.7%, p = 0.009). No serious infectious complications were noted, although a patient developed sepsis after transrectal biopsy.ConclusionsTransperineal software fusion biopsy provided a higher csPC detection rate than transrectal cognitive fusion biopsy and carried minimal risk for infectious complications in patients with MRI-visible prostate lesions.

MRI/US fusion transperineal versus transrectral biopsy of prostate cancer: Outcomes and complication rates, a tertiary medical center experience in the Middle East.

To report on the outcomes of transperineal versus transrectal magnetic resonance imaging/ultrasound fusion biopsy of the prostate including detection of clinically significant cancer and complications. This is the first and largest series in the Middle East. Between May 2019 and June 2020, 145 patients with suspicious lesions on magnetic resonance imaging underwent magnetic resonance imaging/ultrasound fusion prostate biopsy at our center. Transperineal biopsy was performed under light sedation, while transrectal biopsy patients had a periprostatic block for anesthesia. Clinically significant cancer was defined as Gleason ≥3+4 Results: In all, 98 transperineal biopsies and 47 transrectal magnetic resonance imaging/ultrasound fusion prostate biopsies were done. Patients had similar prebiopsy parameters (transperineal vs. transrectal): median age (64.5 vs. 66 years; P=.68), median prostate-specific antigen value (7.5 vs. 7.5; P=.42), and median prostate volume (51 vs. 52.5; P=.83). Those that underwent transperineal biopsy had fewer average total number of cores compared to transrectal ultrasound-guided biopsy (11 vs. 13; P=.025) fewer average number of random cores (3 vs. 6; P < .0001), and the detection rate of clinically significant cancer was similar between the groups (44% vs. 48.9%; P=.57). No difference in hematuria, retention, and sepsis rate requiring admission (1 vs. 2; P=.2) was observed. However, more patients had urinary tract infection in the transrectal ultrasound-guided biopsy group compared to transperineal biopsy group (5 vs. 1; P=.006) that were treated with antibiotics on outside basis. Magnetic resonance imaging/ultrasound transperineal fusion biopsy has similar detection rate of clinically significant cancer compared to transrectal ultrasound-guided biopsy with less urinary tract infection post biopsy.

Initial experience and cancer detection rates of office-based transperineal magnetic resonance imaging-ultrasound fusion prostate biopsy under local anesthesia.

We aimed to demonstrate feasibility and cancer detection rates of office-based ultrasound-guided transperineal magnetic resonance imaging-ultrasound (MRI-US) fusion (TFB) prostate biopsy under local anesthesia. With institutional review board approval, records of men undergoing TFB in the office setting under local anesthesia were reviewed. Baseline patient characteristics, MRI findings, cancer detection rates, and complications were recorded. The PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD, U.S.), along with UroNav 3.0 image-fusion system (Invivo International, Best, The Netherlands) were used for all procedures. Following biopsy, men were surveyed to assess patient experience. Between January 2019 and February 2020, 200 TFBs were performed, of which 141 (71%) were positive for prostate cancer, with 117 (83%) Gleason grade group 2 or higher. A total of 259 of 265 MRI lesions were biopsied, with 127 (49%) positive overall. Prostate Imaging-Reporting and Data System (PI-RADS) 4-5 lesions were positive for prostate cancer in 59% of cases. The mean procedural time was 20 minutes, with a patient enter-to-exit room time of 54 minutes. There were no septic complications, no patients required post-procedure hospital admission, and all procedures were successfully completed. Seventy-five percent of patients surveyed reported complete resolution of pain at three days following the procedure. Office-based TFB represents a viable approach to prostate cancer detection following prostate MRI. Larger-scale assessment is needed to categorize cancer detection rates more accurately by PI-RADs subset, patient selection factors, complication rate, and cost relative to TFB under anesthesia.

A0320 - Transperineal fusion biopsies and target fusion cryoablation under local anesthesia in a clinical office-setting

A0320 - Transperineal fusion biopsies and target fusion cryoablation under local anesthesia in a clinical office-setting

A0467 - Diagnostic performance of Fusion (US/MRI guided) prostate Biopsy: Comparison of elastic transrectal versus rigid transrectal versus rigid transperineal fusion system

A0467 - Diagnostic performance of Fusion (US/MRI guided) prostate Biopsy: Comparison of elastic transrectal versus rigid transrectal versus rigid transperineal fusion system

V14-10 MRI/US FUSION GUIDED PROSTATE BIOPSY AND CRYOTHERAPY IN A CLINICAL OFFICE SETTING

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-10 MRI/US FUSION GUIDED PROSTATE BIOPSY AND CRYOTHERAPY IN A CLINICAL OFFICE SETTING Fernando Bianco, Eusebio Luna, Luanda Perez, Alberto Lopez-Prieto, Edward Gheiler, Ariel Kaufman, Farshad Shafizadeh, Michael Zachareas, Juan Martinez-Salamanca, Gloria Egui-Benatuil, and Michael Kattan Fernando BiancoFernando Bianco More articles by this author , Eusebio LunaEusebio Luna More articles by this author , Luanda PerezLuanda Perez More articles by this author , Alberto Lopez-PrietoAlberto Lopez-Prieto More articles by this author , Edward GheilerEdward Gheiler More articles by this author , Ariel KaufmanAriel Kaufman More articles by this author , Farshad ShafizadehFarshad Shafizadeh More articles by this author , Michael ZachareasMichael Zachareas More articles by this author , Juan Martinez-SalamancaJuan Martinez-Salamanca More articles by this author , Gloria Egui-BenatuilGloria Egui-Benatuil More articles by this author , and Michael KattanMichael Kattan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Cancer Society estimates that 248,530 men (1 out of every 8) will be diagnosed with prostate cancer during 2021. MR/US has brought precision a in diagnosis and opportunity to decrease harm associated to whole gland radical interventions. The interest to develop new ablative therapies has risen as a resource to prevent overtreatment. We have developed a transperineal fusion approach that allows for precise diagnosis and treatment in the office setting under local anesthesia. METHODS: NCT02381990 represents a meticulous prospective registry that aims to characterize outcomes after MR/US Fusion Cryoablation in the office setting. Between 2014 and 2020, 369 patients positive for prostate cancer after MR/US Transperineal Fusion Biopsy (TPFBx) underwent targeted MR/US Transperineal Fusion Cryoablation (TPFTx) across 4 institutions. The video shows a representative case. We present short term outcomes for these patients. RESULTS: The median time from biopsy to treatment for the 369 patient cohort was 6 weeks. All 738 procedures were completed with median times (TPFBx and TPFTx, 24’ and 55’, respectively) and median pain scores (1-10 scale) were 3(TPFBx) and 2(TPFTx). 160 of these patients had TPFTx within during 2020. Of the reminder 209, 173 completed 1-year TPFBx and 57 (32%) were positive. The Gleason groups distribution for those with a 1-year positive biopsy were more favorable than the initial diagnostic TPFBx CONCLUSIONS: MRI/US Fusion prostate biopsies and cryoablation allow targeting prostate cancer lesions in a safe, accurate, and reproducible manner. This approach prevents overtreatment and could be considered an alternative to active surveillance as 68% of patients have no evidence of disease a year after treatment. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1168-e1168 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando Bianco More articles by this author Eusebio Luna More articles by this author Luanda Perez More articles by this author Alberto Lopez-Prieto More articles by this author Edward Gheiler More articles by this author Ariel Kaufman More articles by this author Farshad Shafizadeh More articles by this author Michael Zachareas More articles by this author Juan Martinez-Salamanca More articles by this author Gloria Egui-Benatuil More articles by this author Michael Kattan More articles by this author Expand All Advertisement Loading ...

Evaluation of clinical and mpMRI findings of irreversible electroporation therapy for the treatment of localized prostate cancer: Preliminary results.

To evaluate early clinical and multiparametric prostate magnetic resonance imaging (mpMRI) results of irreversible electroporation (IRE) efficiency in treatment of localized prostate cancer. For the patients in whom IRE was performed for local ablation, mpMRI was used for the sixth month follow-up. These images were compared with the mpMRI images obtained before the procedure. We performed transperineal fusion biopsy to patients with diagnosis of localized prostate cancer. We treated the eligible ones with IRE. Six of them have completed their 6-month follow-up period. We compared preoperative prostate specific antigen (PSA), international prostate symptom score, international index of erectile function (IIEF), and mpMRI of these patients with those obtained at the sixth month of follow-up. Side effects experienced by the patients were evaluated as well. We had 10 patients who received IRE treatment. Six patients completed their sixth month-follow-up and came for control visits. At the end of 6 months, the mean decrease in PSA level was 73%. IIEF results were seen not to have changed significantly. On mpMRI, diffusion restriction was seen to have disappeared except for one patient, and Prostate Imaging Reporting Data System scores were decreased. We concluded that early clinical and mpMRI results for IRE in the focal ablative treatment of localized prostate cancer were gratifying. As an ambulatory procedure with a low incidence of side effects, we look forward to seeing the long-term results of IRE treatment.

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.

The effect of delaying transperineal fusion biopsy of the prostate for patients with suspicious MRI findings—Implications for the COVID-19 era

ObjectiveImage guided biopsies are an integral part of prostate cancer evaluation. The effect of delaying biopsies of suspicious prostate mpMRI lesions is uncertain and clinically relevant during the COVID-19 crisis.We evaluated the association between biopsy delay time and pathologic findings on subsequent prostate biopsy. Materials and methodsAfter obtaining IRB approval we reviewed the medical records of 214 patients who underwent image-guided transperineal fusion biopsy of the prostate biopsy between 2017 and 2019.Study outcomes included clinically significant (ISUP grade group ≥2) and any prostate cancer on biopsy. Logistic regression was used to evaluate the association between biopsy delay time and outcomes while adjusting for known predictors of cancer on biopsy. ResultsThe study cohort included 195 men with a median age of 68. Median delay between mpMRI and biopsy was 5 months, and 90% of patients had a ≤8 months delay. A significant association was found between PI-RADS 5 lesions and no previous biopsies and shorter delay time.Delay time was not associated with clinically significant or any cancer on biopsy. A higher risk of significant cancer was associated with older age (P = 0.008), higher PSA (0.003), smaller prostate volume (<0.001), no previous biopsy (0.012) and PI-RADS 5 lesions (0.015). ConclusionsOur findings suggest that under current practice, where men with PI-RADS 5 lesions and no previous biopsies undergo earlier evaluation, a delay of up to 8 months between imaging and biopsy does not affect biopsy findings.In the current COVID-19 crisis, selectively delaying image-guided prostate biopsies is unlikely to result in a higher rate of significant cancer.