Transperineal Template-guided Prostate Biopsy Research Articles

The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS

BackgroundIn patients with multiparameter magnetic resonance imaging (mpMRI) low-possibility but highly clinical suspicion of prostate cancer, the biopsy core is unclear. Our study aims to introduce the biopsy density (BD; the ratio of biopsy cores to prostate volume) and investigates the BD-predictive value of prostate cancer and clinically significant prostate cancer (csPCa) in PI-RADS<3 patients.MethodsPatients underwent transperineal template–guided prostate biopsy from 2012 to 2022. The inclusion criteria were PI-RADS<3 with a positive digital rectal examination or persistent PSA abnormalities. BD was defined as the ratio of the biopsy core to the prostate volume. Clinical data were collected, and we grouped the patients according to pathology results. Kruskal–Wallis test and chi-square test were used in measurement and enumeration data, respectively. Logistics regression was used to choose the factor associated with positive biospy and csPCa. The receiver operating characteristic (ROC) curve was used to evaluate the ability to predict csPCa.ResultsA total of 115 patients were included in our study. Biopsy was positive in 14 of 115 and the International Society of Urological Pathology grade groups 2–5 were in 7 of all the PCa patients. The BD was 0.38 (0.24-0.63) needles per milliliter. Binary logistics analysis suggested that PSAD and BD were correlated with positive biopsy. Meanwhile, BD and PSAD were associated with csPCa. The ROC curve illustrated that BD was a good parameter to predict csPCa (AUC=0.80, 95% CI: 0.69-0.91, p<0.05). The biopsy density combined with PSAD increased the prediction of csPCa (AUC=0.90, 95% CI: 0.85-0.97, p<0.05). The cut-off value of the BD was 0.42 according to the Youden index.ConclusionIn PI-RADS<3 patients, BD and PSAD are related to csPCa. A biopsy density of more than 0.42 needles per millimeter can increase the csPCa detection rate, which should be considered as an alternative biopsy method when we perform prostate biopsy in patients with PI-RADS<3.

Application of 16 G Biopsy Needle in Transperineal Template-Guided Prostate Biopsy

Background: The aim of this study was to evaluate the clinical value of 16 G biopsy needle in transperineal template-guided prostate biopsy (TTPB), compared with 18 G biopsy needle. Methods: The patients who underwent TTPB from August 2020 to February 2021 were randomized into 2 groups using a random number table. The control group (n = 65) and the observation group (n = 58) performed biopsy with 18 G (Bard MC l820) and 16 G (Bard MC l616) biopsy needles, respectively. Positive rate of biopsy, Gleason score, complications, and pain score were statistically analyzed. Results: The age, prostate volume, PSA, and the number of cores were comparable between the 2 groups. The positive rate of biopsy in the observation group was 68.9% (40/58), meanwhile the control group was 46.2% (30/65). There was statistical difference between the 2 groups (p = 0.011). Gleason score of the observation group (8 [7–9]) was higher than that of the control group (8 [6–9]) (p = 0.038). There was no significant difference in pain score and complications including hematuria, hematospermia, perineal hematoma, infection, and urinary retention between the 2 groups (p > 0.05). Conclusions: 16 G biopsy needle significantly improved the positive rates and accurately evaluate the nature of lesions, meanwhile did not increase the incidence of complications compared with 18 G biopsy needle.

Pre-treatment red blood cell distribution width as a predictor of clinically significant prostate cancer.

The present study aims to assess the relationship between red blood cell distribution width (RDW) and clinically significant prostate cancer (csPCa). A total of 458 patients with prostate-specific antigen (PSA) ≤ 10ng/ml, who subsequently underwent 11-core transperineal template-guided prostate biopsy from June 15, 2015 to November 24, 2020, were included in the present study. Receiver-operating characteristic (ROC)-derived area under the curve analysis was performed to evaluate the predictive accuracy. In addition, univariate and multivariate logistic regression analysis was carried out to determine the association between RDW and csPCa detection. A total of 89 patients were diagnosed with csPCa, and these patients presented with higher median RDW. The optimal RDW cut-off was set at 12.35%, which gained the maximal Yuden's index. In addition to csPCa, RDW demonstrated a positive correlation with age (r = 0.210, P < 0.001). It was observed that RDW was independent of prostate-specific antigen density for csPCa detection. Compared with the low-RDW group, patients in the high-RDW group had a 1.586-fold increased risk of being diagnosed with csPCa (OR = 2.586, P = 0.007). In the ROC analysis, the accuracy level increased by 3.1% for the prediction of csPCa, when RDW was added to the multivariate logistic model. A high-RDW value is an independent risk factor for csPCa detection. However, more large-scale studies are needed to confirm these findings. If validated, RDW can become an inexpensive, non-invasive, and convenient indicator for csPCa prediction.

Development and internal validation of a prediction model of prostate cancer on initial transperineal template-guided prostate biopsy

BackgroundDue to the invasiveness of prostate biopsy, a prediction model of the individual risk of a positive biopsy result could be helpful to guide clinical decision-making. Most existing models are based on transrectal ultrasonography (TRUS)-guided biopsy. On the other hand, transperineal template-guided prostate biopsy (TTPB) has been reported to be more accurate in evaluating prostate cancer. The objective of this study is to develop a prediction model of the detection of high-grade prostate cancer (HGPC) on initial TTPB.ResultA total of 1352 out of 3794 (35.6%) patients were diagnosed with prostate cancer, 848 of whom had tumour with Grade Group 2–5. Age, PSA, PV, DRE and f/t PSA are independent predictors of HGPC with p < 0.001. The model showed good discrimination ability (c-index 0.886) and calibration during internal validation and good clinical performance was observed through decision curve analysis. The external validation of CPCC-RC, an existing model, demonstrated that models based on TRUS-guided biopsy may underestimate the risk of HGPC in patients who underwent TTPB.ConclusionWe established a prediction model which showed good discrimination ability and calibration in predicting the detection of HGPC by initial TTPB. This model can be used to aid clinical decision making for Chinese patients and other Asian populations with similar genomic backgrounds, after external validations are conducted to further confirm its clinical applicability.

The application of a targeted periprostatic nerve block in transperineal template-guided prostate biopsies.

Our study aims to evaluate the anesthetic efficacy of multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted periprostatic nerve block (PNB) for transperineal template-guided prostate biopsy (TTPB). The patients who underwent mpMRI/TRUS fusion-guided prostate biopsy from May 2018 to March 2019 were randomized into two groups using a random number table. The intervention group (n=47) and the control group (n=45) received targeted PNB and traditional PNB, respectively. Visual analog scale (VAS) and visual numeric scale (VNS) scores were used to assess the patients' pain and quantify their satisfaction. The total detection rate for prostate cancer was 45.7%, with a comparable positive rate between the intervention group (42.6%) and the control group (48.9%), which meant there was no significant difference between the groups (P=0.542). Patient age, prostate-specific antigen, prostate volume, suspicious lesions on mpMRI, number of cores, operation time, and biopsy time were comparable between the groups. The VAS scores during biopsy were significantly lower in the intervention group than in the control group [2 (1 to 3) vs. 2 (1 to 4), P=0.019]. Conversely, the VNS scores during biopsy were higher in the intervention group [3 (2 to 4) vs. 3 (2 to 3), P=0.015]. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure between the two groups. There were no significant differences between the groups for complications, such as hematuria, urinary retention, infection, hemospermia, and vasovagal reaction (P>0.05). Targeted PNB significantly relieved the pain and did not increase the incidence of complications for patients when compared with traditional PNB.

Comparison of PI-RADS version 2.1 and PI-RADS version 2 regarding interreader variability and diagnostic accuracy for transition zone prostate cancer.

To compare the diagnostic performance of PI-RADS version 2.1 (PI-RADS v2.1) and PI-RADS v2 for transition zone prostate cancer (TZPC), and analyse its performance for readers with different experience levels. Eighty-five patients with suspected prostate cancer who underwent biopsy after MRI scan between January and December 2017 were retrospectively enrolled. One junior radiologist (reader 1, 1year of experience in using PI-RADS v2) and one senior radiologist (reader 2, 6years of experience) independently reviewed and assigned a score for each lesion according to PI-RADS v2.1 and v2. The template-guided transperineal prostate biopsy was used for standard of reference. To compare the diagnostic performance of the two methods, the AUC was calculated. The sensitivity, specificity, and accuracy were calculated at predefined positive values (PI-RADS ≥ 3). The interreader agreement and frequency of prostate cancer for each PI-RADS category were also calculated. Among the 85 patients, 27 had prostate cancers, and 25 were clinically significant prostate cancer (csPCa). The AUC values for diagnosing clinically significant prostate cancer significantly increased with PI-RADS v2.1 for reader 2 (0.766 vs. 0.902, P = 0.009). The specificity and accuracy for both readers also increased with PI-RADS v2.1 (specificity: reader 1, 41.7% vs. 78.3% and reader 2, 33.3% vs. 81.7%; accuracy: reader 1, 52.9% vs. 76.5% and reader 2, 48.2% vs. 83.5%, all P < 0.05). The interreader agreement was good for both versions. The percentage of prostate cancer decreased in lower PI-RADS categories (PI-RADS 2) and increased in higher PI-RADS categories (PI-RADS 3 ~ 4). Compared with PI-RADS v2, PI-RADS v2.1 may improve radiologists' diagnostic performance for TZPC.

Comparison of value between transperineal template guided biopsy and transrectal biopsy

Objective To compare the effectivity, accuracy and safety of transperineal template guided biopsy and transrectal biopsy for prostate cancer. Methods A total of 220 patients clinically suspected as prostate cancer were divided into transperineal template guided gruop(n=113) and transrectal gruop(n=107). Positive diagnostic rate for prostate cancer was compared. The patients were distributed into different PSA level subgroups including 0-4 ng/mL, 4-10 ng/mL, 10-20 ng/mL and more than 20 ng/mL. And complications including fever and infection, gross hematuria, urinary retention, rectal bleeding, and pain assessment postoperative were compared between the two groups. Results In the PSA 4-10 ng/mL subgroup, the positive rate of prostate cancer in the transperineal template guided group was significantly higher than that in the transrectal group(P 0.05). The incidence of fever and infection, gross hematuriarectal, and rectal bleeding in the transrectal group was significantly higher than that in the transperineal template guided group(P 0.05). In addition, the painscore at 24 h postoperative in the transperineal template guided group was significantly lower than that in the transrectal group(P<0.05). Conclusions The transperineal template guided prostate biopsy is an important method for the early diagnosis of prostate cancer, which is effective, accurate and safe. When PSA is in the gray area of 4-10 ng/mL, the positive rate of prostate cancer by transperineal template guided biopsy is higher. Due to complications and pain are less, which makes most patients more acceptable, it should be better promoted. Key words: Prostatic Neoplasms; Biopsy, Needle; Perineum; Rectum

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

Pelvic plexus block to provide better anesthesia in transperineal template-guided prostate biopsy: a randomised controlled trial

BackgroundTo evaluate the efficacy of pelvic plexus block (PPB) in relief pain during transperineal template-guided prostate biopsy (TTPB), compared with conventional periprostatic nerve block (PNB).MethodsFrom July 2016 to August 2017, 245 patients who were performed TTPB in Clinical Medical College of Yangzhou University were recruited. The patients were randomized into three groups using a random number table. Group-1 received prostate capsule local anesthesia with 22 ml of 1% lidocaine. Group-2 additionally received PNB on the basis of Group-1. To perform PNB, 5 ml 1% lidocaine was injected into the region of prostatic neurovascular bundle situated in the angle of prostate-bladder-seminal vesicle. Group-3 received prostate capsule local anesthesia plus PPB (5 ml of 1% lidocaine injection into the pelvic plexus which located on lateral to the bilateral seminal vesicle apex). The patients’ pain and satisfaction were evaluated by visual analogue scale and visual numerical scale, respectively.ResultsThe age, total prostate volume, PSA and the number of cores were comparable among the three groups. The visual analog scale scores of group-3 were significantly lower than group-2 during biopsy (P = 0.003). Conversely, the visual numeric scale scores were higher in group-3 (P = 0.039). Both the group-2 and group-3 outperformed the group-1 in alleviating pain and had a higher quantification of satisfaction. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure among the three groups.ConclusionsThe analgesic efficacy of PPB guided by Doppler ultrasound in TTPB was better than that of PNB and both were superior to no nerve block.Trial registrationChiCTR-IOR-17013533, 01/06/2016.

Effect of multimodal analgesia using periprostatic nerve block anesthesia combined with flurbiprofen in transperineal template-guided prostate biopsy

Objective: To evaluate the effect of multimodal analgesia using periprostatic nerve block anesthesia (PNB) combined with flurbiprofen in patients undergoing transperineal template-guided prostate biopsy (TTPB). Methods: Totally 166 patients (aged (68.2±9.1) years, range: 47 to 81 years) who received TTPB from October 2017 to June 2018 at Department of Urology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University were enrolled prospectively. All the patients were randomly divided into 2 groups. The observation group (n=79) was given flurbiprofen axetil 1 mg/kg intravenously for half an hour before operation and lidocaine was used for PNB before the biopsy. The control group (n=87) was given normal saline combined with PNB. A visual analog scale (VAS) and visual numeric scale (VNS) were used to assess the patients' pain and quantify their satisfaction at two time points: VAS-1 and VNS-1: during biopsy procedure, VAS-2 and VNS-2: 30 min after the procedure. The date were compared by t test, χ(2) test, Fisher exact test and two-way repeated measures anova analysis between the 2 groups. Results: The age, total prostate volume, serum prostate-specific antigen and the number of cores were comparable among the 2 groups (P>0.05). The VAS-1 scores of the control group and the observation group were 2.8±1.7, 1.9±1.2, respectively, and the VNS-1 were 3.1±0.7, 3.4±0.3, respectively. The VAS-1 were significantly lower in observation group than in control group (F=3.904, P=0.000). Conversely, the VNS-1 were higher in observation group (F=3.526, P=0.000). At 30-minute postoperative, the VAS-2 and VNS-2 were 0.7±0.4 and 3.7±0.2 in the control group, respectively. The VAS-2 and VNS-2 were 0.6±0.5 and 3.8±0.1 in the observation group, respectively. There were no significant differences in the pain scores or the satisfaction scores between the 2 groups (F=1.429, 2.825; P=0.136, 0.083). The incidence of overall complications was 26.4% (23/87) in the control group and 25.3% (20/79) in the observation group, with no statistical difference between the 2 groups (χ(2)=0.027, P=0.869). And the complications had no statistically significant difference among the 2 groups including hematuria, urinary retention, infection, hematospermia, vascular and neurological reactions, nausea, vomiting, dizziness, headache, and respiratory depression (P>0.05). Conclusion: The multimodal analgesia induced by PNB and flurbiprofen could effectively relieve the pain for patients who received TTPB.

The transverse and vertical distribution of prostate cancer in biopsy and radical prostatectomy specimens

BackgroundProstate biopsy is the most common method for the diagnosis of prostate cancer and the basis for further treatment. Confirmation using radical prostatectomy specimens is the most reliable method for verifying the accuracy of template-guided transperineal prostate biopsy. The study aimed to reveal the spatial distribution of prostate cancer in template-guided transperineal saturation biopsy and radical prostatectomy specimens.MethodsBetween December 2012 to December 2016, 171 patients were diagnosed with prostate cancer via template-guided transperineal prostate biopsy and subsequently underwent laparoscopic radical prostatectomy. The spatial distributions of prostate cancer were analyzed and the consistency of the tumor distribution between biopsy and radical prostatectomy specimens were compared.ResultsThe positive rate of biopsy in the apex region was significantly higher than that of the other biopsy regions (43% vs 28%, P < 0.01). In radical prostatectomy specimens, the positive rate was highest at the region 0.9–1.3 cm above the apex, and it had a tendency to decrease towards the base. There was a significant difference in the positive rate between the cephalic and caudal half of the prostate (68% vs 99%, P < 0.01). There were no significant differences between the anterior and posterior zones for either biopsy or radical prostatectomy specimens.ConclusionThe tumor spatial distribution generated by template-guided transperineal prostate biopsy was consistent with that of radical prostatectomy specimens in general. The positive rate was consistent between anterior and posterior zones. The caudal half of the prostate, especially the vicinity of the apex, was the frequently occurred site of the tumor.

631 - Utility of early transperineal template-guided prostate biopsy for risk stratification in men undergoing active surveillance for prostate cancer

631 - Utility of early transperineal template-guided prostate biopsy for risk stratification in men undergoing active surveillance for prostate cancer

The influence of transperineal template-guided prostate saturation biopsy on erectile function

Objective To evaluate the erectile function following transperineal template-guided prostate saturation biopsy (TTPSB). Methods From June 2013 to October 2015, patients underwent prostate biopsy. All patients were indicated for biopsy according to the criteria of Guidance on diagnosis and treatment of urology in China . Exclusion criteria include medical history of PCa, severe urinary tract infection, severe cardiovascular and cerebrovascular diseases or abnormal blood coagulation .All patients were divided into observation group (TTPSB) or control group (traditional trans-perineal template-guided prostate biopsy, TTPB) according to patients′ condition, pubic anatomy, PSA abnormality, rectal examination, imaging examination and pain tolerance, etc. Patients were evaluated for pre-biopsy erectile function with the international index of erectile function (IIEF-5). All pathology confirmed prostate cancer patients were excluded. Concomitant systemic diseases and medications that would interfere with erectile function were recorded. Patients who withdrew from the trial or used the drugs such 5-phosphodiesterase inhibitors for sexual activity improvement were excluded. Ninety-seven patients in observation group and 84 patients in control group underwent further evaluation with the IIEF-5 questionnaire at 1, 3 and 6 months post-biopsy. Results The average age of the observation group and the control group were (64.1±7.9 )years and (61.8±8.9) years, PSA were (7.2±3.7) ng/ml and (6.7±3.4) ng/ml, prostate volume were (47.8±21.5)ml and (49.2±22.2)ml, and the BMI were (21.4±3.1)kg/m2 and (20.6±3.4) kg/m2, respectively. There was no significant difference between the two groups (P>0.05) in term of above patients' characteristics. The pre-biopsy IIEF-5 score of the observation group and the control group were 19.1±4.5 and 19.7±4.3, which had no significant difference (t=-0.890, P=0.375 ). One month after biopsy, the IIEF-5 of two groups were 17.4±4.8 and 18.2±4.5 respectively and both group had statistically significant difference when compared with pre-biopsy (both P<0.05), however, there was no statistical significance at 3 and 6 months after biopsy. Besides, no significant difference of the IIEF-5 score was detected between two groups in 1, 3 and 6 months. Conclusions Although TTPSB may resulted in temporary (1 month) post-biopsy erection dysfunction, the erectile function recovered to pre-biopsy level at 3-6 months post-biopsy. TTPSB did not increase the risk of ED compared with traditional TTPB. Key words: Prostatic neoplasms; Saturation biopsy; Erection dysfunction

Complications of transperineal template‐guided prostate biopsy: A single centre experience in 109 cases

AimThe aim of the current study was to present the complications for patients undergoing a template‐guided transperineal prostate biopsy (TPB) at a single centre.Patients and MethodsData from 109 consecutive patients undergoing TPB over a 1‐year period were analysed. TPB was performed as a day‐case procedure under general anaesthesia. At the time of induction, patients received a single dose of coamoxiclav as the prophylactic antibiotic. This is in contrast to transrectal ultrasound‐guided prostate biopsy, which frequently uses multiple antibiotics and for an extended period.ResultsThe mean age of the studied patients was 65 years, the mean prostate‐specific antigen value was 10.45 ng/L and the mean prostate volume was 61.5 mL. Eight patients (7.2 per cent) were identified as having experienced morbidity due to TPB. Three patients (2.8 per cent) developed urinary retention in the immediate postoperative period. Five patients (4.6 per cent) attended the emergency department at the institution with a presentation related to the procedure; one due to pain, one due to haematuria and three from urinary retention (despite having passed urine after the operation).ConclusionThere was a low incidence of complications following TPB at this institution. Specifically, there were no cases of infection related to the procedure. The most common morbidity resulting from TPB was urinary retention. Future research should be targeted towards investigating ways to minimize the risk of urinary retention following TPB.

The detection and upgrade rates of prostate adenocarcinoma following transperineal template-guided prostate biopsy - a tertiary referral centre experience.

IntroductionWe aim to present transperineal template-guided prostate biopsy (template biopsy) outcomes at a tertiary referral centre. Furthermore, to identify the detection rate of prostate cancer in those with a previous negative transrectal ultrasound guided prostate biopsy and the upgrade rate of those on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma.Material and methodsWe conducted a prospective study of 200 consecutive men who underwent template biopsy over a 22-month period in a tertiary referral centre, using a standard 24 region template prostate biopsy technique. Indications and histology results, as well as complications, were recorded.ResultsMedian age was 67 years and median PSA was 10 ng/mL. Overall detection rate was 47%. 39.5% of cases with previous negative transrectal biopsies were found to have prostate adenocarcinoma. 47.5% of cases on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma were upgraded. The most frequent complication was acute urinary retention at a rate of 12.5%, however, the use of a single prophylactic dose of tamsulosin was found to be beneficial, with 13 cases needed to treat to prevent one episode.ConclusionsTemplate biopsies are safe and efficacious with an overall detection rate of 47% in the present series. Due to the high detection rate, one must consider template biopsy following one negative transrectal biopsy where there is persistent clinical suspicion. Furthermore, those considering active surveillance for Gleason 3 + 3 = 6 disease should be offered template biopsy to confirm the grade of their disease.

Transperineal Template Guided Prostate Biopsy Selects Candidates for Active Surveillance—How Many Cores are Enough?

Most prostate cancer active surveillance protocols recommend a confirmatory biopsy within 3 to 6 months of diagnosis. Transperineal template guided biopsy is an approach to improve the detection of high grade prostate cancer. However, to our knowledge the optimal technique is unknown. We evaluated the relative performance of 2 transperineal template guided biopsy approaches. Institutional review board approved prospective databases at Virginia Mason and University of Michigan were used. Men eligible for active surveillance based on initial 12-core biopsy demonstrating NCCN® guideline low risk prostate cancer were included in study. All men underwent confirmatory transperineal template guided biopsy between 2005 and 2014, and within 6 months of diagnosis. The biopsy technique was based on a 24-core template with 12 anterior and 12 posterior cores or a template based on gland volume with an average of 1 core per cc. Outcome comparisons were made by the chi-square and Fisher exact tests, the Welch t-test and linear regression. Of the 135 men 46 underwent 24-core biopsy and 89 underwent volume based biopsy (median 62 cores). No statistically significant difference was noted in the prevalence of upgrading (35% vs 29%, p = 0.64) or complications (9% vs 16%, p = 0.38) between the 24-core and volume based groups. The difference in the probability of upgrading by volume based biopsy adjusted for age, prostate specific antigen, prostate volume, clinical stage and number of prior biopsies was -4% (95% CI -24 to 14%, p = 0.63). A significant difference was not detected in upgrading or morbidity between a 24-core template and a more exhaustive volume based template. A less invasive 24-core transperineal template guided biopsy strategy may suffice to accurately identify men who are appropriate for active surveillance.

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

MP12-18 FOCAL THERAPY FOR PROSTATE CANCER: THE UTILITY OF A CONFIRMATORY TRANSPERINEAL TEMPLATE GUIDED PROSTATE BIOPSY TO IDENTIFY APPROPRIATE CANDIDATES

You have accessJournal of UrologyImaging/Radiology III1 Apr 2014MP12-18 FOCAL THERAPY FOR PROSTATE CANCER: THE UTILITY OF A CONFIRMATORY TRANSPERINEAL TEMPLATE GUIDED PROSTATE BIOPSY TO IDENTIFY APPROPRIATE CANDIDATES Khanh Pham, Claudio Jeldres, John Corman, Katherine Odem-Davis, Erika Wolff, and Christopher Porter Khanh PhamKhanh Pham More articles by this author , Claudio JeldresClaudio Jeldres More articles by this author , John CormanJohn Corman More articles by this author , Katherine Odem-DavisKatherine Odem-Davis More articles by this author , Erika WolffErika Wolff More articles by this author , and Christopher PorterChristopher Porter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.453AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal Therapy (FT) is considered a promising potential treatment option for men with low risk prostate cancer (CAP). FT may not be suitable for men with high volume, multifocal and high Gleason (GL) grade disease. The current standard to determine low risk CAP is 12-core transrectal ultrasound prostate biopsy (TRUS BX). We had 2 aims: 1. Determine the accuracy of a confirmatory staging 24-core transperineal template guided prostate biopsy (TP BX) 2. Evaluate the efficacy of TP BX to identify candidates for FT. METHODS For both aims we used an IRB approved prospective database to evaluate 172 men who underwent 24-core TP BX between 1/2009 and 8/2013. For Aim 1: Men with CAP who underwent 24-core TP BX and were treated with RP were evaluated. For Aim 2: Men who were candidates for FT based on an initial 12-core TRUS BX that demonstrated NCCN guideline low risk (cT1-2a, GL grade 6, PSA < 10), unifocal (< 2 positive cores) CAP were evaluated. Confirmatory 24-core TP BX was performed 3 months after initial TRUS BX under anesthesia using gray scale TRUS combined with the brachy-stepper device. The template included 12 cores obtained from the anterior prostate (base, mid and apex) together with 12 posterior lateral cores (base, mid and apex). RESULTS For Aim 1: 25 men had TP BX followed by RP. GL grade at TP BX significantly agreed with RP for 21/25 men; accuracy = 0.8 (95% CI: 0.59, 0.93; p=0.004). At RP, 23/25 men had anterior tumor (AT). TP BX sensitivity to RP detection of AT = 0.57 (95% CI: 0.34, 0.77; p=0.67). For Aim 2: 46 men met inclusion criteria. Following TP BX: 16 men demonstrated upgraded pathology with an estimated risk of 0.35 (95% CI: 0.21, 0.50), 20 men had increased volume of disease with an estimated risk of 0.44 (95% CI: 0.29, 0.59) and 30 men had multifocal tumors with an estimated risk of 0.65 (95% CI: 0.50, 0.79). Table 1 lists detailed results of TP BX. All 23 men (50%) with upgraded pathology or increased volume also had multifocal tumors detected. CONCLUSIONS Our analysis of carefully performed TP BX in men eligible for FT by TRUS BX indicates that TP BX accurately indicates GL Grade (0.8), and up to 50% of patients considered for FT have more aggressive multifocal CAP. While our results require confirmation in larger series, we believe TP BX may be important in men considering FT for low risk CAP. Table 1. Grade, Volume, Multifocality and Anteriorly Located Disease Following 24-Core TP Biopsy for Men Identified with Low Risk CAP by 12-Core TRUS Biopsy (N=46) Gleason Grade N (%) Mean PSA Mean PSAD Increased Volume N (%) Multifocal Disease N (%) Anteriorly Located Disease N (%) 3+3=6 30 (65) 5.2 0.12 7 (15) 14 (30) 15 (33) 3+4=7 11 (24) 8.4 0.17 8 (19) 11 (24) 10 (22) 4+3=7 1 (2) 7.4 0.16 1 (2) 1 (2) 1 (2) 4+4=8 1 (2) 5.0 0.20 1 (2) 1 (2) 1 (2) 4+5=9 2 (4) 6.7 0.13 2 (4) 2 (4) 2 (4) 5+4=9 1 (2) 4.5 0.14 1 (2) 1 (2) 1 (2) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e112-e113 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Khanh Pham More articles by this author Claudio Jeldres More articles by this author John Corman More articles by this author Katherine Odem-Davis More articles by this author Erika Wolff More articles by this author Christopher Porter More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Outcomes of transperineal template‐guided prostate biopsy in 409 patients

To present the template-guided transperineal prostate biopsy (TPB) outcomes for patients of two urologists from a single institution. We conducted a prospective study of 409 consecutive men who underwent TPB between December 2006 and June 2008 in a tertiary referral centre using a standardized 14-region technique. The procedure was performed as day surgery under general anaesthesia with fluoroquinolone antibiotic cover. Follow-up took place within 2 weeks, during which time men were interviewed using a standardized template. Results were compared with those of the Australian national prostate biopsy audits performed by the Urological Society of Australia and New Zealand (USANZ). Indications for biopsy included elevated prostate-specific antigen (PSA) level (75%), with a median PSA level of 6.5 ng/mL, abnormal digital rectal examination (8%) and active surveillance (AS) re-staging (18%). The mean patient age was 63 years and two-thirds of patients were undergoing their first biopsy. A positive biopsy was found in 232 men, 74% of whom had a Gleason score of ≥7. The overall cancer detection rate was 56.7% (USANZ 2005 national audit = 56.5%). Stratified between those having their first TPB or a repeat procedure (after a previous negative biopsy), the detection rates were 64.4 and 35.6%, respectively. Significantly higher detection rates were found in prostates <50 mL in volume than in larger prostates (65.2 vs 38.3%, respectively, P < 0.001). Haematuria was the most common side effect (51.7%). Others included dysuria (16.4%), acute urinary retention (4.2%) and fever (3.2%). One patient (0.2%) had septicaemia requiring i.v. antibiotics. Repeat biopsy was not associated with increased complication rates. TPB is a safe and efficacious technique, with a cancer detection rate of 56.7% in the present series, and a low incidence of major side effects. Stratified by prostate volume, the detection rate of TPB was higher in smaller glands. Given the relatively low rate of serious complications, clinicians could consider increasing the number of TPB biopsy cores in larger prostates as a strategy to improve cancer detection within this group. Conversely, in patients on AS programmes, a staging TPB may be a superior approach for patients undergoing repeat biopsy so as to minimize their risk of serious infection.