Transrectal Ultrasound-guided Prostate Biopsy Research Articles

Comparison of 2 effect-site concentrations of remifentanil with midazolam during transrectal ultrasound-guided prostate biopsy under procedural analgesia and sedation: A randomized controlled study.

Until now, target-controlled infusion of remifentanil with midazolam for transrectal ultrasound-guided prostate biopsy has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for transrectal ultrasound-guided prostate biopsy under procedural analgesia and sedation. A prospective, randomized controlled trial including patients who received a transrectal ultrasound-guided prostate biopsy between February 2019 and January 2021 was conducted. Group 1 and Group 2 were respectively administered an initial effect-site concentration of remifentanil of 1.0 ng/mL and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL to keep patient comfort with acceptable pain (remaining moveless), and mean arterial pressure and heart rate within baseline levels ± 30%, and using intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4. The primary outcome was to determine which effect-site concentration of remifentanil provide adequate patient comfort with acceptable pain (remaining moveless) during the procedure. A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between Group 1 and Group 2, except Group 1 having higher peripheral oxygen saturation while probe insertion compared with Group 2. Group 2 patients had less intraoperative movements affecting the procedure (2 vs 18; P < .001), and less total times of target-controlled infusion pump adjustment (0 [0-1] vs 1 [0-3], P < .001) compared with group 1. However, group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 9, P = .002) and less remifentanil consumption (94.9 ± 25.5 μg vs 106.2 ± 21.2 μg, P = .034) compared to Group 2. In transrectal ultrasound-guided prostate biopsy, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided sufficient analgesia and sedation, and appropriate hemodynamic and respiratory conditions.

Prostate Cancer with Multiple Bone Metastases Presenting as Intermittent Flank Pain: A Case Report

&lt;p&gt;一名有腎結石病史的55歲男性，約2週前開始出現騎摩托車時震動引起雙側間歇性腰痛而至家庭醫學科門診就診。尿液分析無異常，腹部X光(KUB)沿著泌尿系統的區域也沒有結石影像。但意外發現雙側髂骨以及側面腰薦椎X光多處腰椎椎體呈現成骨性病灶。因合併prostate-specific antigen)升高，在高度懷疑攝護腺癌合併多處骨轉移之下，個案轉診至泌尿科進一步檢查，經直腸超音波導引攝護腺切片和骨骼掃描確診為攝護腺癌合併多處骨轉移。&lt;/p&gt; &lt;p&gt;本文總結了有關腰痛鑑別診斷和攝護腺癌骨轉移表現的文獻。由於腰痛是基層醫業常見的主訴，本病例報告應有助於提醒基層醫師，非典型腰痛病人應考慮可能致命的攝護腺癌骨轉移，尤其是合併出現任何危險信號的中年男性。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;We reported a 55-year-old man with a history of renal stone who experienced for two weeks intermittent bilateral flank pain, which was precipitated by vibration when riding a motorcycle. He later went to a family medicine department for further examination. Urinary analysis showed no specific finding, and the KUB disclosed no radiopaque along the supposed urinary territory. However, numerous osteoblastic lesions at bilateral iliac bone and multiple lumbar vertebral bodies were accidentally found on the X-ray of the lumbosacral spine lateral view. Due to an elevated prostate-specific antigen level, he was referred to the urological department. Prostate cancer with multiple bone metastases was first suspected and later diagnosed by transrectal ultrasound guided prostate biopsy and bone scan.&lt;/p&gt; &lt;p&gt;The literature on differential diagnosis of flank pain and presentation of prostate cancer with bone metastasis were reviewed herein. Because flank pain is a common complaint in primary care, this case report should help remind primary physicians to consider the potentially fatal prostate cancer with bone metastasis for patients with atypical flank pain, especially for middle-aged patients complicated with red flag signs.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Oral antibiotics perturbation on gut microbiota after prostate biopsy.

IntroductionThe use of antibiotics may induce the changes in gut microbiota. Previous studies have shown conflicting results on whether the changed gut microbiota by antibiotics can be recovered. Our study aims to investigate whether the gut microbiota could be recovered after a single dose of oral co-amoxiclav before transrectal ultrasound-guided transperineal prostate biopsy (TPPBx) in 5 weeks’ time.MethodsFifteen patients with elevated serum prostate-specific antigen (PSA) were recruited to provide pre-antibiotic and post-antibiotic fecal samples. The V4 region of 16S rRNA was sequenced. Analysis was performed by QIIME2. Alpha- and beta-diversities were analyzed, as well as the differential enrichment by Linear discriminant analysis Effect Size (LEfSe) analysis.ResultsBoth the alpha- and beta-diversities of the pre- and post-antibiotic fecal samples were significantly different. Genera that are associated with alleviation of inflammation were enriched in the pre-antibiotic fecal samples, while the inflammation-associated genera were more enriched in the post-antibiotic fecal samples.ConclusionA single dose of oral co-amoxiclav before TPPBx could have led to a change of gut microbiota that cannot be recovered in 5 weeks' time. Microbiome studies on prostate cancer patients should be cautioned on the use of post-prostate biopsy fecal sampling. Further studies should be conducted for the impact on gut microbiome for TPPBx alone.

Comparison of 68Ga-PSMA PET/CT and mp-MRI in regard to local staging for prostate cancer with histopathological results: A retrospective study.

Imaging modalities are used to diagnose and clinical grading of clinically significant prostate cancer. In this study, 68Ga-PSMA PET/CT (PSMA) and multiparametric prostate MRI (mp-MRI) were compared in regard to locating intraprostatic tumor and locoregional staging. After ethics committee approval, a total of 49 patients with prostate cancer who had mp-MRI and PSMA before radical prostatectomy were included. Preoperative and postoperative PSA, transrectal ultrasound-guided prostate biopsy (TRUS-Bx) ISUP grade, radical prostatectomy ISUP grade, body mass index (BMI), TRUS prostate volume, mp-MRI tumor mapping, PSMAtumor mapping, pathologic tumor mapping, extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node invasion (LNI), and bladder neck invasion (BNI)were retrospectively evaluated. Index tumor was located by uroradiologist, nuclear medicine specialist, and uropathologist on a 12-sector prostate pathology map and compared with each other in terms of accuracy and locoregional clinical staging. Mean age of the patients was 66.18 ± 6.67 years and the mean of preoperative PSA results was 21.11 ± 32.56 ng/ml. Nearly half of the patients' (44.9%) pathology was reported as ISUP grade 4 and 5% and 18.4% of patients were surgical margin positive. According to the pathological findings, 362 out of 588 sectors were tumor-positive, 174 out of 362 sectors were tumor-positive in mp-MRI, and 175 out of 362 sectors were tumor-positive in PSMA. Both PSMA and mp-MRI were comparable (p = 0.823) and accurate to detect the location of the intraprostatic index tumor (AUC = 0.66 vs. 0.69 respectively, p = 0.82). The sensitivity and the specificity of the PSMA and mp-MRI for localizing intraprostatic index tumors were 42.5% versus 49.5% and 90.7% versus 88.6% respectively. mp-MRI was more accurate than PSMA in terms of EPE (AUC = 0.8 vs. AUC = 0.57 respectively, p = 0.027) and both methods were comparable in terms of SVI (AUC = 0.75 vs. AUC = 0.75, p = 0.886) and BNI (AUC = 0.51 vs. AUC = 0.59, p = 0.597). PSMA and mp-MRI were comparable in terms of LNI (AUC = 0.76 vs. AUC = 0.64, p = 0.39). mp-MRI should be considered for its high accuracy in the diagnosis of EPE, especially before decision-making for nerve-sparing surgery in high-risk patients. Both imaging modalities were accurate for localizing intraprostatic index tumor. PSMA is accurate for detecting LNI.

Using deep learning to detect patients at risk for prostate cancer despite benign biopsies

SummaryRoutine transrectal ultrasound-guided systematic prostate biopsy only samples a small volume of the prostate and tumors between biopsy cores can be missed, leading to low sensitivity to detect clinically relevant prostate cancers (PCa). Deep learning may enable detection of PCa despite benign biopsies. We included 14,354 hematoxylin-eosin stained benign prostate biopsies from 1,508 men in two groups: men without established PCa diagnosis and men with at least one core biopsy diagnosed with PCa. A 10-Convolutional Neural Network ensemble was optimized to distinguish benign biopsies from benign men or patients with PCa. Area under the receiver operating characteristic curve was estimated at 0.739 (bootstrap 95% CI:0.682–0.796) on man level in the held-out test set. At the specificity of 0.90, the model sensitivity was 0.348. The proposed model can detect men with risk of missed PCa and has the potential to reduce false negatives and to indicate men who could benefit from rebiopsies.

Prediction of a novel prostate-specific antigen density cutoff value and use of transrectal ultrasound-guided prostate biopsy for diagnosis of prostate cancer in Thailand

Objective: The measurement of prostate-specific antigen density (PSAD) is a noninvasive and inexpensive practice, which may improve the accurate diagno- sis of prostate cancer. The incidence of prostate cancer in Thailand is relatively low compared with that in Western countries. Therefore, a blanket adoption of the Western cutoff value (PSAD 0.15 ng/ml/cm3) is inapplicable and can lead to unnecessary biopsies. The aim of this study was to determine an optimal PSAD cutoff value for effective diagnosis in Thai men. Materials and Methods: We retrospectively studied transrectal ultrasound-guided prostate biopsies from 542 men with intermediate PSA concentrations ranging from 4 to 10 ng/ml, carried out from January 2011 to January 2017. The area under the receiver operating characteristic curve (AuROC) was used to evaluate the efficacy of PSAD for the diagnosis of prostate cancer. Results: In Thai men who had intermediate PSA concentrations, the AuROC was higher for PSAD in comparison to that of PSA (0.692 vs 0.544). The AuROC using the PSAD cutoff value = 0.20 ng/ml/cm3 was higher than that using the PSAD cutoff value = 0.15 ng/ml/cm3 (0.652 vs 0.626). The sensitivity, specificity, positive predictive value, and negative predictive values were 67.33%, 62.13%, 29.95%, and 89.15%, respectively. Conclusion: PSAD improved the diagnosis of prostate cancer in Thai men with intermediate PSA concentrations. The optimal cutoff value was 0.20 ng/ml/cm3.

Artificial Intelligence System for Predicting Prostate Cancer Lesions from Shear Wave Elastography Measurements.

(1) Objective: To design an artificial intelligence system for prostate cancer prediction using the data obtained by shear wave elastography of the prostate, by comparing it with the histopathological exam of the prostate biopsy specimens. (2) Material and methods: We have conducted a prospective study on 356 patients undergoing transrectal ultrasound-guided prostate biopsy, for suspicion of prostate cancer. All patients were examined using bi-dimensional shear wave ultrasonography, which was followed by standard systematic transrectal prostate biopsy. The mean elasticity of each of the twelve systematic biopsy target zones was recorded and compared with the pathological examination results in all patients. The final dataset has included data from 223 patients with confirmed prostate cancer. Three machine learning classification algorithms (logistic regression, a decision tree classifier and a dense neural network) were implemented and their performance in predicting the positive lesions from the elastographic data measurements was assessed. (3) Results: The area under the curve (AUC) results were as follows: for logistic regression—0.88, for decision tree classifier—0.78 and for the dense neural network—0.94. Further use of an upsampling strategy for the training set of the neural network slightly improved its performance. Using an ensemble learning model, which combined the three machine learning models, we have obtained a final accuracy of 98%. (4) Conclusions: Bi-dimensional shear wave elastography could be very useful in predicting prostate cancer lesions, especially when it benefits from the computational power of artificial intelligence and machine learning algorithms.

Antibiotic prophylaxis in patients who had undergone to prostate biopsy in between the EMA warning era: effects of fluoroquinolones in diabetic and non-diabetic patients. Results of an observational cohort study

PurposeTo investigate the effects of different antibiotic prophylaxis regimens in patients with diabetes mellitus (DM) candidates to trans-rectal ultrasound-guided prostate biopsy (TRUSPB).Methods143 outpatients with DM who underwent TRUSPB during the period 2018–2020 were selected from a cohort of 1150 patients in 3 different institutions. Exclusion criteria were allergies, concomitant anti-platelet therapies and uncontrolled DM. Different antibiotic prophylaxis regimens were adopted. Bacterial resistance levels to fluoroquinolones into the different communities were also collected. Univariable and multivariable binomial logistic regression analyses were used to assess the odds ratio (OR) with 95% confidence intervals (CIs) testing the risk of infective complications' occurrence after adjusting for clinical covariates.ResultsOverall, DM patients were significantly associated with infective complications' occurrence (p < 0.001). No differences on the event of sepsis were found between diabetic and non-diabetic patients. Clinically relevant infections with fever > 37 °C were found in 9.1% and 1.5% (p < 0.001) in diabetic and non-diabetic patients, respectively. Trimethoprim–sulphametoxazole and fluoroquinolones were six times more efficient than Cefixime in non-diabetic patients. Fluoroquinolones confirmed the same effect in diabetic patients although the level of resistance in the period of study decreased only from 56 to 46%.ConclusionFluoroquinolones were active in antibiotic prophylaxis of diabetic patients who had undergone to TRUSPB independently from the level of bacterial resistance found in the community. These results conflict with the recent European warning and support the Japanese and American guidelines on the topic.

Infection complications after transrectal ultrasound-guided prostate biopsy: A radiology department's experience and strategy for improvement.

Transrectal ultrasound (TRUS)-guided prostate biopsy is a common procedure performed to diagnose prostate cancer. The risk of infection complications is well-described in the literature, and strategies to avoid such complications continue to evolve over time. We performed a retrospective review of our infection complications and propose a strategy for improvement. We reviewed clinical outcomes from patients undergoing TRUS-guided prostate biopsy at our institution from November 2018 to November 2020. We reported the antimicrobial prophylaxis received, whether the biopsy was systematic or targeted, and we examined the rate of clinically significant infection complications and hospitalization. Among 312 men who underwent TRUS-guided prostate biopsy during the study period, seven (2.2%) had an infection. Four patient groups with distinct antimicrobial regimen were identified; the largest of these patient groups received a three-day course of cefixime and a single dose of fosfomycin (59%). The proportion of patients with infection complications across these groups did not demonstrate a statistically significant difference (p=0.803). There was no significant difference in proportion of infection between systematic and targeted biopsy groups (3.0% vs. 0%, p=0.204). The proportion of patients hospitalized was 1.3%, with a mean length of stay of four days. We report a rate of clinically significant infection following TRUS-guided prostate biopsy of 2.2%. Due to our referral pathway, we have an inconsistent approach to antimicrobial prophylaxis, although there was no statistically significant difference in infection rate between the groups. We propose a standardized approach that may lead to improved patient outcomes.

The Evaluation of Goal-Directed Antibiotics Prophylaxis Applied Via Rectal Swab Before Transrectal Ultrasound-Guided Prostate Biopsy

The Evaluation of Goal-Directed Antibiotics Prophylaxis Applied Via Rectal Swab Before Transrectal Ultrasound-Guided Prostate Biopsy

MP09-03 THE EFFICACY OF ADJUVANT AMIKACIN TO ORAL LEVOFLOXACINE FOR PREVENTION OF FEBRILE COMPLICATIONS FOLLOWING TRANSRECTAL PROSTATE BIOPSY

You have accessJournal of UrologyCME1 May 2022MP09-03 THE EFFICACY OF ADJUVANT AMIKACIN TO ORAL LEVOFLOXACINE FOR PREVENTION OF FEBRILE COMPLICATIONS FOLLOWING TRANSRECTAL PROSTATE BIOPSY Yoshitsugu Nasu, and Taiki Kanbara Yoshitsugu NasuYoshitsugu Nasu More articles by this author , and Taiki KanbaraTaiki Kanbara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fluoroquinolones have been commonly used for antibiotic prophylaxis before transrectal ultrasonography guided prostate biopsy (TRPB). The possession of fluoroquinolone-resistant E. coli (QREC) in rectal flora is thought to be a risk factor off ebrile complications following TRPB and culture-based antimicrobial selection was recommended for patients with QREC. Amikacin (AMK) is promising agent because of potent antimicrobial activity against QREC and excellent permeability to the prostate tissue. We evaluated the efficacy of adjuvant AMK to oral levofloxacin (LVFX) as prophylaxis for TRPB. METHODS: From October 2016 to September 2021, a total of 426 patients who underwent TRPB were enrolled. Prior to TRPB, rectal swabs were cultured. Isolated E. coli was determined as QREC when their minimum inhibitory concentration (MIC) of LVFX was 4 μg/mL or above according to the breakpoint MIC by the Clinical and Laboratory Standards Institute criteria. As antimicrobial prophylaxis for all patients, a single oral 500mg of LVFX was administered two hours before TRPB. For patients with QREC in rectal flora (QREC carriers), single dose of 400mg of AMK was added intravenously before TRPB. All biopsies were carried out through a standard 12-core approach with local periprostatic anesthesia. Additional targeted biopsy was done in some patients. The patients were followed up for 4 weeks after TRPB and febrile infective complications were recorded. RESULTS: Forty QREC carriers (9.4%) were detected in this study. All of E.coli isolated from QREC carriers were sensitive to AMK. A total of 10 patients (2.3%) suffered from febrile complications following TRPB. Three of them were QREC carriers and the others were non-QREC carriers. The incidence of febrile complications following TRPB among QREC carriers was higher than that of non-QREC carriers (7.5%, 3/40vs 1.8%, 7/386; p=0.058, Fisher′s exact test). CONCLUSIONS: The adjuvant AMK to oral LVFX was not so effective in QREC carrier, although all strains of isolated E. coli from QREC carrier were sensitive to AMK. We concluded the culture-based antimicrobial prophylaxis had a limitation of complete prevention of febrile complications following TRPB. While escalation or further augmentation of prophylactic agents will reduce febrile complications in a short time, these will accelerate the increase of resistant bacteria in a long time and violate the principal of good antibiotic stewardship. For resistant strain carriers, the switching to transperieal prostate biopsy should be considered. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e135 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoshitsugu Nasu More articles by this author Taiki Kanbara More articles by this author Expand All Advertisement PDF DownloadLoading ...

How many cores are enough? Optimizing the transperineal prostate biopsy template

Most urologists use a 10-12 core template during transrectal ultrasound guided prostate biopsy (TRUS-B). A similar consensus template does not exist for transperineal prostate biopsy (TP-B) including the optimal number and location of biopsy cores. We examined our institutional cohort to develop an optimal systematic template for TP-B. We prospectively monitored our first 200 consecutive free-hand TP-B. These included men who were biopsy naïve (n = 117), had elevated PSA with prior negative biopsy (n = 18), and men on active surveillance (n = 65). All men underwent a 20 core TP-B with each core placed in a separate specimen container. This allowed the 20-core TP-B to be easily broken down as though fewer cores had been taken in each patient. Ten, 12, and 16 core templates were designed a priori and compared within each patient to the 20 core template. The highest Grade Group (GG) at pathologic analysis was assigned to each biopsy. Primary outcome was detection of clinically significant prostate cancer, defined as ≥GG2. Secondary outcome was detection of GG1 prostate cancer. We performed sub-group analyses of biopsy naïve men and biopsy naïve men stratified by PSA density (<0.15 vs. ≥0.15 ng/mL/cc). An historic institutional cohort of 10-12 core TRUS-B (n = 170) was used to compare prostate cancer detection between techniques. P value of ≤0.05 was considered statistically significant. Clinically significant cancers were detected in 98 men (49%) using a 20 core TP-B technique. Had we sampled fewer cores we would have identified clinically significant cancers in 93 (47%, 16 core), 91 (46%, 12 core), and 82 (41%, 10 core) men. More clinically significant cancers were detected by the 20 core template compared to the 10 core template for both the whole cohort (49% vs. 41%, P = 0.02) and the biopsy naïve subset (48% vs. 40%, P = 0.05). Additional cores did not result in an increased detection of GG1 cancers (20-core: 35% vs. 10-core: 44%, P = 0.09). Less than one quarter of biopsy naïve men with a PSA density <0.15 were found to have clinically significant cancers. More clinically significant cancers were detected in the 12-core TP-B cohort compared to the 12-core TRUS-B series (46% vs. 38%, P < 0.001). A 20 core TP-B systematic biopsy template detected a greater number of clinically significant prostate cancers compared to a 10 core TP template. Cancer detection was similar for 12, 16, and 20 core templates. Higher core numbers did not result in greater detection of GG1 tumors reflecting increased detection of concomitant ≥GG2 with greater sampling. We propose a minimum 12 core systematic biopsy template for men undergoing TP-B.

MP30-14 ENVIRONMENTAL IMPACT OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyCME1 May 2022MP30-14 ENVIRONMENTAL IMPACT OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Michael Leapman, Cassandra Thiel, Ilyssa Gordon, Adam Nolte, Aaron Perecman, Michael Overcash, and Jodi Sherman Michael LeapmanMichael Leapman More articles by this author , Cassandra ThielCassandra Thiel More articles by this author , Ilyssa GordonIlyssa Gordon More articles by this author , Adam NolteAdam Nolte More articles by this author , Aaron PerecmanAaron Perecman More articles by this author , Michael OvercashMichael Overcash More articles by this author , and Jodi ShermanJodi Sherman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare is a major contributor to global pollution. Reducing the over-use of clinical care is one solution to lowering environmental emissions and improving care value. We aimed to estimate the environmental impact of transrectal ultrasound (TRUS) prostate biopsy, a procedure that is commonly performed in excess of recommended guidelines based on patient age or life-expectancy. METHODS: We performed a cradle-to-grave life cycle assessment (LCA) to estimate environmental emissions associated with a single TRUS biopsy. Data included materials and energy inventory, as well as patient and staff travel across 3 process-steps: a pre-biopsy prostate magnetic resonance imaging (MRI), TRUS biopsy, and pathology laboratory processing. We performed sensitivity analyses to assess contributions from waste, travel, and energy use. The primary endpoint was greenhouse gas (GHG) emissions (CO2 equivalents, CO2e), calculated using LCA tools Ecoinvent (a database of emissions) and the US Environmental Protection Agency’s TRACI 2.1 v1.04 (Tool for Reduction and Assessment of Chemicals and Other Environmental Impacts). We estimated the potential environmental impacts associated with reductions in the annual number of biopsies performed. RESULTS: A single prostate biopsy procedure involving prostate MRI emits an estimated 78.7 kg CO2e. Overall, energy was the largest contributor to CO2 emissions, with an estimated 46.8kg CO2e, 59.5% of the procedural total. Staff travel contributed 20.0kg CO2e (25.4%), followed by supply production (10.2kg CO2e, 13%). Integration of a prostate MRI process step contributed an estimated 42.3kg CO2e, 53.8% of the total emissions. Reduction of prostate biopsy (per 100,000 procedures) would avoid the equivalent of 7.87x106 kg CO2e, the equivalent of 190,778,876 miles driven by an average passenger vehicle. CONCLUSIONS: Although prostate biopsy is a small-scale procedure, it contributes a calculable environmental footprint. Reducing the number of prostate biopsies performed, in line with best clinical practice, would also result in significant reductions in health care pollution. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e483 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Leapman More articles by this author Cassandra Thiel More articles by this author Ilyssa Gordon More articles by this author Adam Nolte More articles by this author Aaron Perecman More articles by this author Michael Overcash More articles by this author Jodi Sherman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Decision-making based on International Society of Urological Pathology Gleason-scores obtained from transrectal needle biopsy of the Prostate: How Accurate Could We Be ?

Objective: The decision about the treatment of localized prostate cancer (PC) depends mainly on the histopathological results of transrectal needle biopsy. The agreement between the results of transrectal needle biopsies and radical prostatectomy specimens were reported to be varying. In this study, we aimed to investigate one institution’s homogenous repertory. A fair agreement could be revealed, and probable strategies to improve the rate of agreement are discussed.&#x0D; &#x0D; Materials and Methods: 230 eligible patients who underwent radical prostatectomy (RP) and transrectal ultrasound guided prostate biopsy (TRUS-Bx) in our instutition were included in the study. Demographic characteristics, PSA levels (ng/ml) prior to TRUS-Bx, International Society of Urological Pathology (ISUP) Gleason group grades obtained from TRUS-Bx and RP were recorded and evaluated for concordance.&#x0D; &#x0D; Results:137 of 250 patients RP pathology ISUP Gleason grades were compatible with TRUS-Bx pathology results (%59,6). 20 of 125 (%16) patients who reported to be ISUP Gleason grade 2 or 3 or 4 or 5 in initial biopsy found to be downgraded and 42 of 147 patients (29%), reported to have ISUP Gleason grade 1 upgraded in the final pathology.&#x0D; &#x0D; Conclusion: In the diagnosis of PC, TRUS-Bx is an insufficient method to show the correct ISUP Gleason grade in radical prostatectomy specimen pathology.

Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy.

Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03–0.48, p = 0.003 and OR 0.17, 95% CI 0.06–0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04–0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00–0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.

Association of Warmer Weather and Infectious Complications Following Transrectal Ultrasound-Guided Prostate Biopsy.

The seasonal and meteorological factors in predicting infections after urological interventions have not been systematically evaluated. This study aimed to determine the seasonality and the effects of the weather on the risk and severity of infectious complications (IC) after a transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Using retrospectively collected data at the tertiary care hospital in Taiwan, we investigated the seasonal and meteorological differences in IC after TRUS-Bx. The IC included urinary tract infection (UTI), sepsis, and a positive culture finding (PCF). The severity was assessed on the basis of the Common Terminology Criteria for Adverse Events grading system. The prevalences of the infectious complications (UTI, sepsis, PCF and grade ≥ 3 IC) were significantly higher in the summer than in the winter. Monthly temperature and average humidity were significant factors for IC. After adjusting the demographic factors, multivariate regression revealed that UTI, sepsis, PCF, and grade ≥ 3 IC increased by 12.1%, 16.2%, 21.3%, and 18.6% for every 1 °C increase in the monthly average temperature, respectively (UTI: p = 0.010; sepsis: p = 0.046; PCF: p = 0.037; grade ≥ 3 IC: p = 0.021). In conclusion, the development and severity of IC after TRUS-Bx had significant seasonality. These were dose-dependently associated with warmer weather. Infectious signs after TRUS-Bx should be monitored more closely and actively during warm weather.

The Effect of Different Types of Prostate Biopsy Techniques on Post-Biopsy Infectious Complications.

The aim of our study was to compare infectious complication rates between different prostate biopsy techniques with various number of biopsy cores. In this retrospective study, all patients from 2 hospitals who underwent prostate biopsy between 2012 and 2019 were identified. Cohorts with different types of prostate biopsies were compiled within these hospitals. Primary outcome measure was any registered infectious complication within 7 days post-biopsy. Secondary outcomes were infectious complications within 30 days, hospitalization and bacteremia. To compare the risk of infection following different prostate biopsy techniques, data was fitted into a logistic regression model adjusting for potential confounders. In total, 4,233 prostate biopsies in 3,707 patients were included. After systematic transrectal ultrasound-guided prostate biopsy (TRUSPB; 12±1.4 biopsy cores), 4.0% (2,607) of all patients had infectious complications within 7 days post-biopsy. Transperineal magnetic resonance imaging (MRI)-ultrasound fusion guided prostate biopsy (16±3.7 biopsy cores) was associated with significantly lower infection rates than systematic TRUSPB (adjusted OR: 0.29 [0.09-0.73] 95% confidence interval [CI]). Transrectal targeted MRI-ultrasound fusion guided prostate biopsy (3.1±0.8 biopsy cores) and transrectal targeted in-bore MRI guided prostate biopsy (2.8±0.8 biopsy cores) also showed fewer infectious complications than systematic TRUSPB (adjusted OR: 0.41 [0.12-1.12] 95% CI and 0.68 [0.37-1.20] 95% CI, respectively). Transperineal prostate biopsy, or transrectal prostate biopsy with reduced number of biopsy cores, could lower the risk of infectious complications.

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

We evaluated the surgical margin status after radical prostatectomy according to sites positive for prostate cancer on standard 12-core transrectal ultrasound-guided prostate biopsy. Among patients who underwent radical prostatectomy at Boramae Medical Center, 520 patients with preoperative prostate-specific antigen (PSA) level < 20 ng/mL and locally confined prostate cancer on preoperative magnetic resonance imaging, treated with nerve-sparing radical prostatectomy, were included in the analysis. The surgical margin was positive for cancer in 166 (31.9% of the total) patients. The preoperative PSA level (9.3 vs. 8.0, ng/mL p = 0.001) and number of positive cores on 12-core prostate biopsy (4.1 vs. 3.4, p = 0.003) were significantly higher in patients with positive surgical margins. Moreover, the biopsy Gleason grade was higher in patients with positive surgical margins (p = 0.001). However, the pathologic Gleason grade and tumor volume were equivalent between the 2 groups. On multivariate analysis, the detection of prostate cancer on anterior lateral biopsy was associated with an increased rate of positive surgical margins (hazard ratio [HR]: 1.781, p = 0.008) after adjusting for other variables. Anterior lateral (HR: 1.919, p = 0.020), basal lateral (HR: 9.176, p < 0.001), basal medial (HR: 3.302, p = 0.031), and mid lateral (HR: 2.501, p = 0.044) biopsies were associated with positive apical, posterior, basal, and lateral surgical margins, respectively, after adjusting for other variables. The sites of prostate cancer on standard 12-core prostate biopsy could be useful for predicting surgical margin positivity after radical prostatectomy. In other words, clinicians should consider the sites of prostate cancer on prostate biopsy to reduce margin positivity after radical prostatectomy.

Schistosomiasis of the Prostate in Sokoto, Nigeria: a case series

BackgroundProstate schistosomiasis is a chronic inflammatory condition of the prostate. In an endemic environment, it may mimic the sinister condition of the prostate in its clinical presentation. Despite the high prevalence of urinary schistosomiasis documented in our environment, prostate involvement is rarely encountered in routine clinical practice. We report and share our experience in the management of two cases of prostate schistosomiasis that presented with abnormal digital rectal examination and elevated prostate-specific antigen suggestive of prostate cancer but proved otherwise by the histology report.Case presentationThe first patient was a 50-year-old man who presented with a history of voiding and storage lower urinary tract symptoms (LUTS) and urinary retention relieved by urethral catheterization. There was no other significant history except for past childhood terminal hematuria. The remarkable findings on physical examination were in the digital rectal examination which revealed enlarged prostate, hard, nodular, obliterated median groove, and restricted mobility of overlying rectal mucosa. The total serum prostate-specific antigen (PSA) was 1.2 ng/ml. Transrectal ultrasound-guided prostate biopsy and histology confirmed prostate schistosomiasis on a background of nodular hyperplasia. The second patient was an 80-year-old man who presented with a history of voiding and storage lower urinary tract symptoms (LUTS) and urinary retention relieved by urethral catheterization. There was no other significant history and no past childhood terminal hematuria. There were no remarkable findings on physical examination except for the enlarged prostate with benign findings on digital rectal examination. The initial total serum prostate-specific antigen (PSA) was 31.0 ng/ml. The repeated PSA was 7.5 ng/ml after antimicrobial therapy. Transrectal ultrasound-guided prostate biopsy and histology confirmed prostate schistosomiasis on a background of nodular hyperplasia. He had two sessions of Bipolar Transurethral Resection of the Prostate following failed medical treatment.ConclusionsSchistosomiasis of the prostate may mimic the clinical or biochemical presentation of prostate cancer. The attending physician requires high index of suspicion to arrive at this diagnosis, especially for the urologist practicing in an endemic area.

Implications and effects of COVID-19 on diagnosis and management of prostate cancer.

The Coronavirus disease 2019 (COVID-19) pandemic has led to uncertainty on the optimal management for prostate cancer (PCa). This narrative review aims to shed light on the optimal diagnosis and management of patients with or suspected to have PCa. Faecal-oral or aerosol transmission is possible during prostate procedures; caution must be in place when performing digital rectal examinations, transrectal ultrasound-guided prostate biopsies and prostate surgeries requiring general anaesthesia. Patients must also be triaged using preoperative polymerase chain reaction tests for COVID-19. COVID-19 has accelerated the adoption of multiparametric Magnetic Resonance Imaging (MRI), reducing the need for prostate biopsy unless when absolutely indicated, and the risk of COVID-19 spread can be reduced. Combined with prostate-specific antigen (PSA) density, amongst other factors, multiparametric MRI could reduce unnecessary biopsies in patients with little chance of clinically significant PCa. Treatment of PCa should be stratified by the risk level and preferences of the patient. COVID-19 has accelerated the development of telemedicine and clinicians should utilise safe and effective teleconsultations to protect themselves and their patients. COVID-19 transmission during prostate procedures is possible. Patients with a Prostate Imaging-Reporting and Data System (PI-RADS) of <3 and PSA density <0.15 ng/ml/ml are deemed low-risk and are safe to undergo surveillance without MRI-targeted biopsy. Intermediate- or high-risk patients should be offered definitive treatment within four months or 30days of diagnosis to avoid compromising treatment outcomes; three-month courses of neoadjuvant androgen deprivation therapy can be considered when a delay of surgery is anticipated.