Transperineal Template Prostate Biopsy Research Articles

Selective biomarkers for inflammation and infection are associated with post-operative complications following transperineal template prostate biopsy (TTPB): a single-centre observational clinical pilot-study

BackgroundProstate cancer (PCa) and benign prostatic hyperplasia (BPH) are the most common prostate disorders in the UK, which cause considerable ill health in older men. Transperineal template prostate biopsy (TTPB) has emerged as a reliable procedure for the histopathological diagnosis of PCa and BPH due to its higher cancer detection rates. Although antiseptic preparation and antibiotic prophylaxis are used to ensure safety in patients undergoing surgical intervention, post-operative complications, such as infection and bleeding are still unavoidable, resulting in re-admissions, with resource implications. Currently, there is no biomarker profile to predict outcomes or monitor patients during the post-operative course. The main aim of this single-centre observational clinical pilot-study was to investigate the role of inflammatory and infection biomarkers following TTPB and their association with post-operative complications.MethodsForty-five patients scheduled for elective TTPB were recruited after informed consent at the Wrexham Maelor and Glan Clwyd Hospitals, North Wales, UK (n = 45). Prior to surgery, venous blood samples were collected at baseline and subsequently at 30, 120, and 240 min post-operatively. Urine samples were collected before and 120 min after the procedure. Serum procalcitonin (PCT), serum ferritin, and urine B2MG analysis were done using enzyme-linked fluorescent assay (ELFA) and the magnetic Luminex® multiplex performance assay was used to analyse IL-6, IL-8, IL-10 and TNF-α plasma concentrations. Data on clinical outcomes were collected from patients’ medical records.ResultsFollowing TTPB, significant (p ≤ 0.05) increases were observed in uB2MG, IL-6, IL-8, IL-10 and TNF-α. Significant decreases were observed in ferritin (p ≤ 0.05). No significant change was observed in PCT concentration (p ≥ 0.05). One patient developed an infection and severe haematuria post-operatively following TTPB.ConclusionAlthough not confirmative, changes seen in biomarkers such as uB2MG, IL-10 and TNF-α in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications such as infection and bleeding which can develop following TTPB for the diagnosis of PCa and BPH.

Effect of transperineal template prostate biopsy on perioperative and functional outcomes following robotic-assisted radical prostatectomy

Objective: This study aimed to determine the effect of template transperineal (TTP) compared to transrectal (TR) biopsy on surgical and functional outcomes after robotic-assisted radical prostatectomy (RARP). Methods: From 2014 to 2018, 280 patients underwent RARP by a single surgeon. Of these, 184 had TR, and 96 had TTP biopsy. Primary outcomes were continence and erectile function recovery (EFR) rates up to 24 months postoperatively. Secondary outcomes comprised positive margin rates and markers of a difficult operation, including operative time, estimated blood loss (EBL), urethral preservation quality and ability to perform planned nerve-sparing surgery. Results: The median age was greater in the TTP group (64 vs. 62 years, p=0.028). The proportions of men with preoperative erectile dysfunction and men undergoing nerve-sparing surgery were not different between groups. Operative time, EBL, urethral preservation quality, proportion of men undergoing intended nerve-sparing procedure, positive margin rates and continence recovery rates were not different among the groups. At 24 months, men in the TR group had a higher EFR rate on univariate analysis ( p=0.036), and multivariate analysis ( p=0.03). Conclusion: TTP biopsy was not associated with markers of a more difficult RARP or worse oncological and continence recovery outcomes but did appear to impact upon long-term rates of EFR. Level of evidence: Level 4.

Combined Utility of 68Ga-Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging in Predicting Prostate Biopsy Pathology

Background68Gallium-labelled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA-11 PET) is a valuable staging tool, but its utility in characterising primary prostate cancer remains unclear. The maximum standardised uptake value (SUVmax) is a quantification measure of highest radiotracer uptake within PET-avid lesions. ObjectiveTo assess the utility of SUVmax in detecting clinically significant prostate cancer (csPCa) on biopsy alone and in combination with multiparametric magnetic resonance imaging (mpMRI). Design, setting, and participantsThis was a retrospective analysis of 200 men who underwent 68Ga-PSMA-11 PET/CT, mpMRI, and transperineal template prostate biopsy between 2016 and 2018. Outcome measurements and statistical analysisThe primary and secondary outcomes were detection of grade group (GG) 3–5 and GG 2–5 prostate cancer, respectively. We used the Mann-Whitney U test to compare SUVmax by GG, and calculated sensitivity and specificity for csPCa detection via 68Ga-PSMA-11 PET/CT, mpMRI, and both. Multivariable logistic regression analyses were used to identify predictors of csPCa on biopsy. Results and limitationsThe median SUVmax was greater for GG 3–5 tumours (6.40, interquartile range [IQR] 4.47–11.0) than for benign and GG 1–2 tumours (3.14, IQR 2.55–3.91; p < 0.001). The median SUVmax was greater for GG 3 (5.70, IQR 3.68–8.67) than for GG 2 (3.47, IQR 2.70–4.74; p < 0.001). For GG 3–5 disease, sensitivity was 86.5%, 95.9%, and 98.6%, and the negative predictive value (NPV) was 88.4%, 88.5%, and 93.3% using SUVmax ≥4, a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3–5, and both, respectively. This combined model detected more GG 3–5 disease than mpMRI alone (98.6% vs 95.9%; p = 0.04). SUVmax was an independent predictor of csPCa for GG 3–5 disease only (odds ratio 1.27 per unit, 95% confidence interval 1.13–1.45). Our results are limited by the retrospective study design. ConclusionsGreater SUVmax on 68Ga-PSMA-11 PET/CT is associated with detection of GG 3–5 cancer on biopsy. The combination of PI-RADS score and SUVmax provides higher sensitivity and NPV than either alone. 68Ga-PSMA-11 PET/CT may be useful alongside mpMRI in improving risk stratification for localised disease. Patient summaryThe amount of a radioactive tracer taken up in the prostate during a type of scan called PET (positron emission tomography) can predict whether aggressive prostate cancer is likely to be found on biopsy. This may complement the more usual type of scan, MRI (magnetic resonance imaging), used to detect prostate cancer.

Predictors of erectile dysfunction after transperineal template prostate biopsy.

PurposeTo investigate the incidence and possible contributing factors of erectile dysfunction (ED) after transperineal template prostate biopsy (TTPB).Materials and MethodsMales undergoing TTPB were prospectively administered a Sexual Health Inventory for Men (SHIM) questionnaire before biopsy and one month after. SHIM questionnaires were repeated at 3- and 9-months for males not receiving interventional treatment. Sexually inactive males were excluded. Interval change in SHIM categories based upon baseline characteristics were evaluated. Multivariable logistic regression models were used to evaluate predictors of change in SHIM score category.ResultsA total of 576 males were included in our sample. Of these, 450 (78%) males underwent their first biopsy. A decline in SHIM category within the immediate 4-weeks post-biopsy was reported by 167 males (31% of total eligible sample). Age was the strongest predictor of decline in SHIM category, the predicted probability of a decline in SHIM at age 50 was 10% (95% confidence interval [CI], 1%–19%), 32% at age 60 (95% CI, 25%–40%) and 36% at age 70 (95% CI, 29%–44%). For new onset ED, the predicted probability of ED within 4-weeks post-TTPB were 6.7% at age 50 (95% CI, 0%–15%), 26% at age 60 (95% CI, 17%–34%) and 31% at age 70 (95% CI, 21%–40%).ConclusionsOlder age at biopsy is an independent predictor of immediate ED after TTPB in sexually active males. This association was observed in the subgroup with no pre-existing ED. These findings provide useful information when counselling males undergoing TTPB.

The 31-month experience of transperineal template prostate biopsy at a rural district general hospital

Introduction: Transperineal template prostate biopsies (TPTPB) have been offered for prostate adenocarcinoma diagnosis since Mar 2017 at Hereford County Hospital, in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS). This assesses the likelihood of clinically-significant cancer based on MRI prostate characteristics. Our study will evaluate this unit’s experience of TPTPB efficacy and safety.

Handling and reporting of transperineal template prostate biopsy in Europe: a web-based survey by the European Network of Uropathology (ENUP).

Transperineal template prostate biopsies (TTPB) are performed for assessments after unexpected negative transrectal ultrasound biopsies (TRUSB), correlation with imaging findings and during active surveillance. The impact of TTPBs on pathology has not been analysed. The European Network of Uropathology (ENUP) distributed a survey on TTPB, including how specimens were received, processed and analysed. Two hundred forty-four replies were received from 22 countries with TTPBs seen by 68.4% of the responders (n = 167). Biopsies were received in more than 12 pots in 35.2%. The number of cores embedded per cassette varied between 1 (39.5%) and 3 or more (39.5%). Three levels were cut in 48.3%, between 2 and 3 serial sections in 57.2% and unstained spare sections in 45.1%. No statistical difference was observed with TRUSB management. The number of positive cores was always reported and the majority gave extent per core (82.3%), per region (67.1%) and greatest involvement per core (69.4%). Total involvement in the whole series and continuous/discontinuous infiltrates were reported in 42.2 and 45.4%, respectively. The majority (79.4%) reported Gleason score in each site or core, and 59.6% gave an overall score. A minority (28.5%) provided a map or a diagram. For 19%, TTPB had adversely affected laboratory workload with only 27% managing to negotiate extra costs. Most laboratories process samples thoroughly and report TTPB similarly to TRUSB. Although TTPB have caused considerable extra work, it remains uncosted in most centres. Guidance is needed for workload impact and minimum standards of processing if TTPB work continues to increase.

Patient experience after transperineal template prostate biopsy compared to prior transrectal ultrasound guided prostate biopsy.

IntroductionTransperineal template prostate biopsy (TTPB) is reported to have higher cancer detection and lower complication rate compared to transrectal ultrasound guided prostate biopsy (TRUSPB).However, there is no report of the same patient's experience with both types of biopsy.To compare the patient reported experience in the same cohort of patients who underwent both TRUSPB and TTPB, using validated questionnaires.Material and methodsWe retrospectively utilised the Patient Reported Outcome Methods (PROM) tool validated for TRUSPB and the International Index of Erectile Function (IIEF-5) questionnaire to collect longitudinal data at follow-up in the same cohort of patients who underwent both TTPB and TRUSPB between January 2015 and February 2016.RESULTSOut of 44 TTPB performed during the period, 35 patients had undergone both TRUSPB and TTPB. Patient reported pain post biopsy was significantly higher with TRUSPB (86% vs. 61%; p = 0.01). Post-biopsy urinary retention rates were significantly higher in the TTPB group (16.7% vs. 5.7%; p = 0.05, t test). Furthermore, the incidence of patient reported sexual dysfunction rates based on the IIEF-5 was significantly higher in the TTPB group (p = 0.001, t test).ConclusionsAlthough overall TTPB was better tolerated in this cohort of patients with lower risk of health care contact, patients reported higher incidence of urinary retention and sexual dysfunction after TTPB compared to TRUSPB. Thus, patients should be adequately informed about potential risks with each biopsy as they may have significant impact on quality of life.

627 - Comparison of patient experience after transperineal template prostate biopsy with prior transrectal ultrasound guided prostate biopsy

627 - Comparison of patient experience after transperineal template prostate biopsy with prior transrectal ultrasound guided prostate biopsy

Ability of an epigenetic assay to identify anterior prostate tumors based on a negative 12-core biopsy.

131 Background: There is increasing awareness that anterior-predominant prostate cancers (PCa) are poorly sampled by 12-core transrectal ultrasound-guided (TRUS) prostate biopsies. Approximately one-fifth of all prostate tumors occur in this area, and many are high grade and extend beyond the prostatic capsule. An epigenetic assay, detecting PCa-specific DNA-methylation of GSTP1, RASSF1 and APC has shown to be a significant predictor for the presence of PCa in histopathologically cancer-negative biopsies through a cancer-associated field effect. It is currently unknown whether the field effect from an anterior-predominant cancer may be detected in standard posteriorly-directed sextant biopsy specimens. Methods: Seven patients with at least one prior negative TRUS biopsy were subsequently diagnosed with anterior-only PCa based on a transperineal mapping template prostate biopsy (MTPB). Three patients were diagnosed with low-grade Gleason score (GS) 6 tumors and four patients with GS ≥7 tumors. The outcome of the MTPB was compared with the result of the epigenetic test performed on the prior cancer-negative TRUS biopsy. Results: MTPB included a median of 68 cores (IQR 53-76). A total of 6 patients (86%) were methylation-positive at initial biopsy, suggesting that the field effect from these anterior-predominant cancers extends to the region of TRUS biopsy sampling. No methylation was found for one patient with only one GS6 positive core at MTPB and a tumor volume of 4%. Methylation intensities were higher for patients with GS ≥7 compared to those with GS6. A logistic regression model combining these intensities with traditional risk factors (PSA, age, TRUS-biopsy pathology and DRE) indicated higher risk scores for high-grade tumors. Conclusions: Aberrant DNA-methylation patterns are present in normal-appearing tissue from TRUS biopsy of patients with anteriorly located tumors. Although a small study, this is a unique cohort that underwent extensive sampling at re-biopsy demonstrating the presence of an anterior-predominant tumor. These results indicate that an epigenetic assay may be valuable even in patients with negative posteriorly-directed TRUS biopsies to detected anterior-predominant PCa.

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

MP53-17 TRANSPERINEAL TEMPLATE PROSTATE BIOPSIES: THE NEW GOLD STANDARD FOR PROSTATE CANCER DIAGNOSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-17 TRANSPERINEAL TEMPLATE PROSTATE BIOPSIES: THE NEW GOLD STANDARD FOR PROSTATE CANCER DIAGNOSIS Shady Nafie, John Dormer, John Kilian Mellon, and Masood Ahmed Khan Shady NafieShady Nafie More articles by this author , John DormerJohn Dormer More articles by this author , John Kilian MellonJohn Kilian Mellon More articles by this author , and Masood Ahmed KhanMasood Ahmed Khan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis. Transperineal template prostate biopsy (TPTPB) has been shown to improve prostate cancer detection in men with a rising PSA and previous negative TRUS guided prostate biopsies. We performed a prospective study directly comparing the prostate cancer detection rate between TRUS guided biopsy and TPTPB in 50 men with a benign feeling DRE, PSA < 20 ng/mL and no previous prostate biopsies. Methods 50 patients with a mean age of 67 years (range: 54-84), mean prostate volume of 58 cc (range:19-165) and mean PSA of 8 ng/L (range: 4-18) underwent standard 12-core TRUS guided prostate biopsy followed immediately by 36-core TPTPB under general anesthetic. We determined the prostate cancer detection rate between the two diagnostic modalities. Results A total of 20/50 (40%) men had benign pathology. Of the 30/50 (60%) diagnosed with prostate cancer 16 (32%) had positive results in both TRUS and TPTPB, while 14 (28%) had negative TRUS but positive TPTPB. Hence, TRUS guided prostate biopsy detected cancer in 32% whereas it was 60% with TPTPB. Furthermore, no cancers were detected solely by TRUS biopsy. In 19/30 (63%) the cancers detected by TPTPB had Gleason score ≥ 7. In total, 2 (4%) patients experienced urosepsis, 7 (14%) temporary urinary retention, 16 (32%) had mild haematuria and 19 (38%) haematospermia. Conclusions TPTPB is associated with a significantly higher prostate cancer detection rate compared to TRUS biopsies (60% vs. 32%, p<0.0001) in men with an elevated PSA < 20 ng/mL and a benign feeling prostate. We propose that TPTPB should be regarded as the biopsy technique of choice in this group of men. In addition, PSA appears to be a better biomarker for prostate cancer than previously thought. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e595 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Shady Nafie More articles by this author John Dormer More articles by this author John Kilian Mellon More articles by this author Masood Ahmed Khan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The role of transperineal template prostate biopsies in prostate cancer diagnosis in biopsy naïve men with PSA less than 20 ng ml−1

To compare prostate cancer detection rates between transrectal ultrasound (TRUS) prostate biopsy and transperineal template prostate biopsy (TPTPB) in biopsy naïve men. TRUS biopsy is still regarded as gold standard for prostate cancer diagnosis. TPTPB has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. We carried out a prospective study performing both biopsies in the same group of men with a benign feeling digital rectal examination (DRE), PSA <20 ng ml(-1) and no previous prostate biopsies. A total of 50 patients with mean age of 67 years (range: 54-84), mean prostate volume 58 cc (range: 19-165) and mean PSA 8 ng l(-1) (range: 4-18) underwent standard 12-core TRUS biopsy followed immediately by 36-core TPTPB under general anaesthetic. We determined the prostate cancer detection rate between the two diagnostic modalities. In total, 20/50 (40%) had benign pathology. Of 30/50 (60%) diagnosed with prostate cancer, 16 (32%) had positive results in both TRUS and TPTPB, whereas 14 (28%) had negative TRUS but positive TPTPB. No cancers were detected solely by TRUS biopsy. TRUS biopsy detected cancer in 32% versus 60% with TPTPB. In total, 19/30(63%) cancers detected by TPTPB had Gleason score > or =7.2 (4%) experienced urosepsis, 7 (14%) temporary urinary retention, 16 (32%) mild haematuria and 19 (38%) haematospermia. TPTPB is associated with significantly higher prostate cancer detection rate than TRUS biopsies in biopsy naïve men with a benign feeling DRE and PSA <20 ng ml(-1). PSA appears to be better biomarker than previously thought.

Transperineal template prostate biopsies in men with raised PSA despite two previous sets of negative TRUS-guided prostate biopsies

The possibility of prostate cancer as a cause for steadily rising PSA despite previously negative transrectal ultrasound (TRUS)-guided prostate biopsies is a major concern. An initial negative TRUS-guided prostate biopsy does not necessarily exclude the presence of clinically significant prostate cancer. We determined the role of transperineal template prostate biopsy (TPTPB) in prostate cancer detection in men with raised PSA despite two previous sets of negative TRUS biopsies. Between January 2008 and August 2012, a total of 122 men's records were reviewed after having 36-core TPTPB following two previous sets of negative TRUS biopsies despite raised PSA. A retrospective record of PSA levels, clinicopathological parameters and histological outcomes was made. Mean age was 63 years (range 49-77), and mean PSA was 18.0 (range 2.0-119.0). A total of 71/122 (58 %) men were diagnosed with prostate cancer on TPTPB. Of these, 28 (39 %), 34 (48 %), 5 (7 %), and 4 (6 %) had Gleason score 6, 7 (3 + 4), 7 (4 + 3), and 9 (4 + 5), respectively. The mean number of positive cores was 7 (range 1-22). Of these, only 15 (21 %) had ≤2 cores positive and Gleason score of 6. Of the 51 (42 %) men with a negative histology on TPTPB, 11 (22 %), 10 (19 %), and 30 (59 %) had atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, or benign pathology. TPTPB is associated with a high rate of clinically significant prostate cancer diagnosis (58 %) in men with raised PSA despite two previous sets of negative TRUS biopsies.

P050 The emerging role of transperineal template prostate biopsy in patients with a persistently raised PSA despite one negative TRUS-guided prostate biopsy

P050 The emerging role of transperineal template prostate biopsy in patients with a persistently raised PSA despite one negative TRUS-guided prostate biopsy

The emerging role of transperineal template prostate biopsy in patients with a persistently raised PSA despite one negative TRUS-guided prostate biopsy

The emerging role of transperineal template prostate biopsy in patients with a persistently raised PSA despite one negative TRUS-guided prostate biopsy

2215 TRANSPERINEAL MAPPING TEMPLATE PROSTATE BIOPSY AFTER PREVIOUS TRANSRECTAL ULTRASOUND PROSTATE BIOPSY DETECTS WORSE DISEASE BURDEN

INTRODUCTION AND OBJECTIVES: Due to systematic sampling of the entire prostate, transperineal mapping template prostate biopsy (MTPB) has become a diagnostic tool in select patients. Current indications include 1) evaluation of persistently elevated PSA despite prior negative trans-rectal ultrasound guided (TRUS) prostate biopsy, and 2) patients initiating active surveillance (AS). However, the diagnostic utility of MTPB in these scenarios remains uncertain. As a result, we sought to determine the rate of new prostate cancer (PCa) diagnosis and Gleason upstaging (worse disease burden)with MTPB following previous TRUS biopsy. METHODS: Using a prospectively maintained institutional database, we identified 84 MTPB performed between 2008-2010 for persistently elevated PSA despite negative TRUS biopsy (32 patients) or as part of the evaluation for initiation of AS following a prior positive TRUS biopsy (52 patients). Previous TRUS biopsies were compared to MTPB results to determine if worse disease burden was identified. Patient characteristics including age, PSA, DRE, prostate volume, and number of prior TRUS biopsies were identified and evaluated for an association with worse disease burden on MTPB with univariable and multivariable logistic regression analyses. RESULTS: Despite a median of 2 (range 16) prior negative TRUS biopsies, MTPB diagnosed new PCa in 19/32 (59.4%) patients with persistently elevated PSA (9.3 ng/dL (IQR 6.9-12.6)), of which 13/19 (68.4%) were Gleason 7 disease (Table). Among patients with known PCa, Gleason score upgrading occurred in 13/52 (25.0%)patients following MTPB. Overall, MTPB identified worse disease burden in 32/84 (38.0%) patients. However, on univariable and multivariable analysis, no patient factors were significantly associated with detection of worse PCa disease burden on MTPB following previous TRUS biopsy. CONCLUSIONS: MTPB identifies worse PCa disease burden in a substantial portion of patients with previous TRUS biopsy, including detection of intermediateor high-grade disease in some patients with prior negative TRUS biopsies. Due to the inability to predict which patients are at risk for worse disease burden, MTPB is a valuable tool to detect biologically more aggressive disease.

Variable Correlation of Grid Coordinates to Core Location in Template Prostate Biopsy

Purpose: Transperineal template prostate biopsy has been proposed to facilitate systematic biopsy in patients undergoing repeat biopsy who are at high risk for cancer. Advocates tout the reliability of the grid to define biopsy location compared to hand-held transrectal ultrasound guided biopsy. However, accuracy of the biopsy needle depends on bevel position, tissue deformity, and technique. Due to this potential for error, we sought to determine whether the use of transperineal template biopsy would assure reproducibly accurate needle placement. Materials and Methods: A standard 0.5 cm brachytherapy grid was utilized for transperineal biopsy. A single grid hole was used to obtain biopsies. The bevel of the needle was rotated to a different position with each biopsy, and the angle of the needle was varied to test the ability of the grid to “map” the prostate. Results: We observed wide variation of needle location through a single brachytherapy grid hole. We are able to show that at 5 cm depth, an area of 2.47 mm² is possible to biopsy and at a depth of 25 cm; approximately 7.56 mm² is possible to biopsy. This gives a precision of biopsy of at the most shallow depth 22% and at the deepest 7%. Conclusion: There is potential for technical and equipment associated error with transperineal template guided prostate biopsy. The grid alone can account for substantial sources of error, so technique remains critical if the grid coordinates are to be used to predict presence or extent of cancer.

Urinary retention following transperineal template prostate biopsy – study of risk factors

Background: As greater numbers of transperineal template prostate biopsies (TTPBs) are being performed, we have noticed that a considerable number of patients experience urinary retention post-procedure. We wanted to quantify this, and to examine factors that might predict which patients will experience retention. Patients and methods: Data analysis was performed on a prospectively maintained database on 93 consecutive patients undergoing template prostate biopsy over a 12-month period. Results: Mean patient age was 66 years (range 46–79). Mean prostate-specific antigen (PSA) was 8.34 ng/ml (1–31), mean transrectal ultrasonography (TRUS) volume 51 cc (10–133) and mean number of cores 52 (11–84). Twenty-five patients had muscle relaxant as part of their anaesthetic (27%). Fifteen patients had haematuria immediately post-procedure (16%). Twenty-six procedures were performed by a urology trainee (28%). Sixteen patients experienced retention post-template biopsy (17%). Their mean age was 67 years, mean PSA 8.9 ng/ml, mean TRUS volume 68 cc and mean number of cores 58. Of the retention group, 10 patients had muscle relaxant (63%), one patient had haematuria (6%) and four procedures were performed by a trainee (25%). Factors that significantly correlated with retention were TRUS volume ( r = 0.36, p = 0.0004) and the use of muscle relaxant ( r = 0.37, p = 0.0003). Age, PSA, number of cores taken, haematuria post-biopsy, and intra-operative furosemide, paracetamol, diclofenac, morphine and dexamethasone were not correlated with retention ( p &gt; 0.05). Conclusion: Patients with higher TRUS volumes are at increased risk of retention post-TTPB and should be counselled accordingly. Due to anti-muscarinic effects, muscle relaxants should not be used.

Transperineal Magnetic Resonance Image Targeted Prostate Biopsy Versus Transperineal Template Prostate Biopsy in the Detection of Clinically Significant Prostate Cancer

Multiparametric magnetic resonance imaging can be used to guide prostate biopsy by targeting biopsies to areas in the prostate at high risk for cancer. We compared the detection of clinically significant and insignificant cancer by transperineal magnetic resonance imaging targeted biopsy and transperineal template guided prostate biopsy. A total of 182 men with a lesion suspicious for cancer on multiparametric magnetic resonance imaging underwent transperineal magnetic resonance imaging targeted biopsy using a cognitive registration technique, followed by systematic transperineal template guided prostate biopsy. The primary outcome was the detection rate of clinically significant prostate cancer. Clinical significance was defined using maximum cancer core length 4 mm or greater and/or Gleason grade 3 + 4 or greater (University College London definition 2). We secondarily evaluated other commonly used thresholds of clinically significant disease, including maximum cancer core length 6 mm or greater and/or Gleason grade 4 + 3 or greater, maximum cancer core length 3 mm or greater and/or Gleason grade 3 + 4 or greater, and maximum cancer core length 2 or greater mm and/or Gleason grade 3 + 4 or greater. Strategies were statistically compared with the McNemar test. Mean ± SD patient age was 63.3 ± 7.2 years. Median prostate specific antigen was 6.7 ng/ml (IQR 4.7-10.0). Clinically significant cancer was detected by magnetic resonance imaging targeted biopsy and template guided prostate biopsy in 103 (57%) and 113 of the 182 men (62%) (p = 0.174), and clinically insignificant cancer was detected in 17 (9.3%) and 31 (17.0%), respectively (p = 0.024). Prostate biopsy targeted to suspicious lesions on multiparametric magnetic resonance imaging has encouraging rates of detection of clinically significant cancer while also decreasing the detection rate of clinically insignificant cancer. This is achieved with fewer biopsy cores than for systematic template guided biopsy. Further prospective, multicenter, comparative trials of the performance of targeting strategies are needed to consider magnetic resonance imaging targeted biopsy an alternative to conventional systematic biopsy.

821 Magnetic resonance image-guided prostate biopsy versus transperineal template prostate biopsy in the diagnosis of clinically significant prostate cancer

821 Magnetic resonance image-guided prostate biopsy versus transperineal template prostate biopsy in the diagnosis of clinically significant prostate cancer