Transrectal Ultrasound Biopsy Research Articles

The impact of metformin use on the risk of prostate cancer after prostate biopsy in patients with high grade intraepithelial neoplasia.

ABSTRACTPurposeWe report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis.Materials and MethodsWe retrospectively analyzed 551 patients with a diagnosis of HGPIN without PCa in a first prostate biopsy. The cohort of the study consisted of 456 nondiabetic subjects, and 95 diabetic patients. Among the patients with diabetes 44 were treated with metformin, and 51 with other antidiabetic drugs. A transrectal ultrasound prostate biopsy scheme with 22 cores was carried out 4-6 months after the first diagnosis of HGPIN.ResultsAmong 195 (35.4%) patients with cancer, there were statistically significant differences in terms of PCa detection (p<0.001), Gleason score distribution (p<0.001), and number of positive biopsy cores (p<0.002) between metformin users and non-users. Metformin use was associated with a decreased risk of PCa compared with neveruse (p<0.001). Moreover, increasing duration of metformin assumption (≥2 years) was associated with decreasing incidence of PCa and higher Gleason score ≥7 compared with assumption <2 years.ConclusionsThis preliminary experience suggests that metformin use may have some beneficial effects in patients with diabetes and HGPIN; metformin should not be overlooked in these patients because it is neither new nor expensive.

Assessment of Needle Tip Deflection During Transrectal Guided Prostate Biopsy: Implications for Targeted Biopsies.

To measure needle tip deflection during transrectal ultrasound (TRUS) prostate biopsy and evaluate predictors for needle tip deflection. Analysis of 568 prostate biopsies obtained from 51 consecutive patients who underwent a standard 12-core TRUS guided prostate biopsy. TRUS guided prostate biopsies were performed using BK flex500, with a side-fire biplane probe. Each biopsy core image was captured and clinical data were recorded prospectively. The angle between the expected trajectory of the needle and actual needle course was measured using the longitudinal view of the captured image. The distance between expected and actual needle tip was calculated. We measured median and interquartile needle tip deflection rate stratified by side and location (apex, midgland, base). Univariable and multivariable linear regressions analysis were performed. The overall median needle tip deflection was 1.77 mm (IQR 1.35-2.47). Location did not significantly alter needle deflection measurements. On multivariable linear regression analysis, higher prostate volume (B = 0.007 95%, CI 0.004, 0.011; p < 0.001) and the right sided biopsy (B = 0.191 95%, CI 0.047, 0.336; p = 0.010) emerged as predictors of higher needle tip deflection. To the best of our knowledge this is the first study to measure needle tip deflection during TRUS guided prostate biopsies. We demonstrated that larger prostate size and biopsy side may affect the accuracy of biopsies. These results may have clinical implication to those performing targeted biopsies.

The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature.

Since the advent of prostate-specific antigen (PSA)-based testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a standard part of the diagnostic pathway for prostate cancer (PCa). Rectal bleeding is one of the common side effects of this transrectal route. While rectal bleeding is usually mild and self-limiting, it can be life-threatening. In this article, we examine rectal bleeding post-TRUS-guided prostate biopsy and explore the literature to evaluate techniques and strategies aimed at preventing and managing this common and important complication. A PubMed literature search was carried out using the keywords "transrectal-prostate-biopsy-bleed." A search of the bibliography of reviewed studies was also conducted. Additionally, papers in non-PubMed-listed journals of which the authors were aware were appraised. Numerous modifiable risk factors for this bleeding complication exist, particularly anticoagulants/antiplatelets and the number of core biopsies taken. Successfully described corrective measures for such rectal bleeding include tamponade (digital/packs/catheter/tampon/condom), endoscopic sclerotherapy/banding/clipping, radiological embolization, and surgical intervention. We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.

Comparative diagnostic efficacy of biopsy strategies for prostate cancer detection: a Bayesian network meta-analysis of 24 randomised controlled trials

BackgroundThe introduction of three kinds of MRI-guided prostate biopsies (MRI-PB) has changed the model of practice regarding prostate biopsies. The most appropriate strategy is still unknown, we therefore aimed to compare and rank prostate biopsies strategies. MethodsWe did a network meta-analysis to incorporate both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Scopus, Embase, and the reference lists of relevant articles for randomised controlled trials published up to Sept 1, 2016, of different strategies for prostate biopsy. Involved studies were full text reports of randomised trials that compared different biopsy strategies, and reported efficacy endpoints. The primary outcome was overall prostate cancer detection rate. We did pairwise meta-analyses by random effects model and network meta-analysis by Bayesian random effects model. We assessed the quality of evidence contributing to each network estimate using the GRADE framework. This study is registered with PROSPERO, number CRD42016044011. FindingsFrom a total of 3616 citations, 24 randomised trials with a total of 6497 participants were included in this network meta-analysis. We considered 11 strategies of prostate biopsy published between 2000 and 2016. Cognitive MRI prostate biopsy was significantly better (relative risk [RR] 2·66, 95% credible interval [CrI] 1·44–4·72) than TRUS (10-12; PCa detection from 10–12 needle core transrectal ultrasound prostate biopsy) prostate biopsy considering overall prostate cancer detection rate. Detection rates of clinically significant and insignificant prostate cancers suggested no significant difference between any group of all biopsy techniques. InterpretationAlthough cognitive MRI prostate biopsy obtained better detection rates of overall prostate cancer than did TRUS (10-12) prostate biopsy, it had no remarkable advantages in detection of clinically significant and insignificant prostate cancers. Nevertheless, these results should be considered together with all known safety and economy information when selecting the strategy for individual patients. FundingThis study was supported by the Prostate Cancer Foundation Young Investigator Award 2013, the National Natural Science Foundation of China (81300627, 81370855) and Programs from Science and Technology Department of Sichuan Province (2013SZ0006, 2014JY0219).

Prospective Outcome Analysis of the Safety and Efficacy of Partial and Complete Cryoablation in Organ-confined Prostate Cancer

To determine the rate of complications and change in International Prostate Symptom Score and Sexual Health Inventory for Men scores following cryotherapy treatment of low- and intermediate-risk prostate cancer. The secondary end points were the change in prostate-specific antigen post cryotherapy and biopsy-proven recurrence. Enrollment occurred from 2007 to 2015 to assess long-term complications of cryotherapy. A prostate biopsy was performed at 1 year or in the event of biochemical failure. Subjects were staged and graded by standard 12- to 14-core transrectal ultrasound (TRUS) biopsy. A subset of subjects underwent additional 3-dimensional mapping biopsy if the cancer was suspected to be downgraded. Analyses of functional outcomes were stratified into focal and nonfocal treatments. The study consisted of 393 men with low- and intermediate-risk prostate cancer, aged 44-89 years. Patient IPSS scores improved significantly in the nonfocal treatment strata at all time points and after 1 year in the focal strata with a median drop at 1 year of 4 points (P <.001). No significant difference was detected for a change in preprocedural SHIM score in either treatment strata after 2 years (P >.7). Eighty-two patients (20.9%) had a rise in prostate-specific antigen resulting in biochemical failure. Seventy patients had detected recurrence for an overall recurrence rate of 20.4% in 343 patients. A total of 109 patients (27.7%) reported urinary retention and urgency post cryotherapy, with 15.3% requiring catheterization for up to 3 weeks. Thirty-seven patients (9.4%) experienced urethral meatal stricture, and 36 patients (9.2%) reported unresolved new-onset erectile dysfunction. Complication rates, most significantly erectile dysfunction, are decreased in this study compared with those previously reported in the literature for cryotherapy for prostate cancer.

The prostate cancer screening clinic in the Bahamas: a model for low- and middle-income countries.

Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements. We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy. Overall, 1,844 males were registered (mean age 57.6years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care. This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.

Tumor marker α-fetoprotein receptor does not discriminate between benign prostatic disease and prostate cancer.

The α-fetoprotein receptor (RECAF) is a proposed novel tumor marker for detecting several different types of tumors, including prostate cancer (PCa). The aim of the study was to evaluate RECAF in discriminating benign prostatic conditions from PCa and to compare it with prostate-specific antigen (PSA). A total of 64 patients with elevated serum PSA levels and/or abnormal digital rectal examination of the prostate referred to a tertiary center for transrectal ultrasound (TRUS) biopsy of the prostate were prospectively enrolled in the study from January 2009 to April 2010. Serum RECAF, total PSA (tPSA) and free PSA (fPSA) concentrations were measured. The results were correlated with histopathologic findings using the Mann-Whitney U test and Kruskal-Wallis χ2 test. The median RECAF concentration was 5.34 U/L in the benign pathology group of patients and 4.72 U/L in the malignant pathology group. The difference was not statistically significant. RECAF density, tPSA and fPSA concentrations and tPSA density were significantly different between the benign and malignant pathology groups (p = 0.033, p = 0.000, p = 0.002 and p = 0.000, respectively). RECAF concentration and RECAF density did not differ significantly in the subgroups of PCa patients stratified according to Gleason score, predominant primary Gleason grade or maximum primary Gleason grade, but in predominant secondary Gleason grade and maximum secondary Gleason grade, significant differences were found (p = 0.007 and p = 0.004, respectively). The results of the study did not confirm the RECAF tumor marker as an alternative way to discriminate between groups of patients with benign prostatic conditions and PCa, and its concentration and density do not differ among PCa histopathologic groups.

The Use of Magnetic Resonance Imaging to Predict Oncological Control Among Candidates for Focal Ablation of Prostate Cancer

To provide insights into the role of multiparametric magnetic resonance imaging (mpMRI) in predicting oncological control following 2 focal ablation (FA) templates for selective cases of prostate cancer. A total of 59 radical prostatectomies were performed between 2012 and 2016 on cases that fulfilled criteria for FA. The Gleason score (GS), extent of Gleason pattern (GP) 4, maximum linear cross-sectional length (MLCSL), and location of tumor foci were recorded and related to scale on corresponding 3-mm transverse slice prostate maps. Gleason pattern 4 extra-focal disease (GP4EFD) was defined as prostate cancer with any GP 4 not detected by mpMRI and transrectal ultrasound systematic biopsy observed outside a specified ablation zone. The location of these GP4EFD relative to the MRI lesion (MRI-L) (contralateral or ipsilateral) was recorded and used to predict oncological control following a hypothetical margin and ipsilateral hemi-ablation templates. Overall, 15 of 59 (25.4%) of the prostate specimens had at least 1 GP4EFD. Of the total 20 GP4EFD, 7 of 20 (35%) were ipsilateral and 13 of 20 (65%) were contralateral to the MRI-L. Of the GP4EFD, 16 of 20 (80%), 2 of 20 (10%), and 2 of 20 (10%) were GS 3 + 4, GS 4 + 3, and GS 4 + 4, respectively. Of these GP4EFD, 10 of 20 (50%) exhibited an MLCSL <5 mm. Ablating only the MRI-L+10 mm or performing an ipsilateral hemi-ablation would leave residual GP4 in 14 of 59 (23.7%) and 11 of 59 (18.6%) of cases, respectively. Because a significant proportion of candidates for FA based on mpMRI and systematic biopsy will have pre-existing GP4EFD outside ablation templates, active surveillance of the untreated prostate is mandatory.

Validation of Prostate Imaging-Reporting and Data System Version 2: A Retrospective Analysis

Use of magnetic resonance imaging (MRI)/transrectal ultrasound fusion biopsies to determine the accuracy of multiparametric MRI (mpMRI), using Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2), for detecting clinically significant prostate cancer in the overall gland and specifically the peripheral zone (PZ) and transitional zone (TZ). A retrospective analysis of patients who underwent fusion biopsy identified 137 men with 231 prostate lesions was approved by the Institutional Review Board. Subjects initially classified under PI-RADSv1 criteria were regraded using PI-RADSv2 by a radiologist blinded to PI-RADSv1 score and biopsy results. Spearman correlation, chi-squared, and logistic regression analysis were performed. There was positive correlation between PI-RADSv2 and Gleason scores (P < 0.001). In the PZ, mpMRI demonstrated 100% sensitivity, 100% negative predictive value, and 35.9% positive predictive value, compared to 100%, 100%, and 27.1%, respectively, for TZ lesions. When predicting clinically significant prostate cancer, the PI-RADSv2 area under the curve for TZ lesions was 0.844 (95% CI: 0.753-0.935, P < 0.001) and 0.769 (95% CI: 0.684-0.854, P < 0.001) for PZ lesions. Combining PI-RADSv2 with additional risk factors (body mass index, prostate-specific antigen density, digital rectal examination) improved the area under curve. PI-RADSv2 achieves excellent sensitivity and negative predictive value for both PZ and TZ lesions.

Characteristics of Prostate Cancer Found at Fifth Screening in the European Randomized Study of Screening for Prostate Cancer Rotterdam: Can We Selectively Detect High-grade Prostate Cancer with Upfront Multivariable Risk Stratification and Magnetic Resonance Imaging?

BackgroundThe harm of screening (unnecessary biopsies and overdiagnosis) generally outweighs the benefit of reducing prostate cancer (PCa) mortality in men aged ≥70 yr. Patient selection for biopsy using risk stratification and magnetic resonance imaging (MRI) may improve this benefit-to-harm ratio. ObjectiveTo assess the potential of a risk-based strategy including MRI to selectively identify men aged ≥70 yr with high-grade PCa. Design, setting, and participantsThree hundred and thirty-seven men with prostate-specific antigen ≥3.0 ng/ml at a fifth screening (71–75 yr) in the European Randomized study of Screening for Prostate Cancer Rotterdam were biopsied. One hundred and seventy-nine men received six-core transrectal ultrasound biopsy (TRUS-Bx), while 158 men received MRI, 12-core TRUS-Bx, and fusion TBx in case of Prostate Imaging Reporting and Data System ≥3 lesions. Outcome measurements and statistical analysisThe primary outcome was the overall, low-grade (Gleason Score 3+3) and high-grade (Gleason Score ≥ 3+4) PCa rate. Secondary outcome was the low- and high-grade PCa rate detected by six-core TRUS-Bx, 12-core TRUS-Bx, and MRI ± TBx. Tertiary outcome was the reduction of biopsies and low-grade PCa detection by upfront risk stratification with the Rotterdam Prostate Cancer Risk Calculator 4. Results and limitationsFifty-five percent of men were previously biopsied. The overall, low-grade, and high-grade PCa rates in biopsy naïve men were 48%, 27%, and 22%, respectively. In previously biopsied men these PCa rates were 25%, 20%, and 5%. Sextant TRUS-Bx, 12-core TRUS-Bx, and MRI ± TBx had a similar high-grade PCa rate (11%, 12%, and 11%) but a significantly different low-grade PCa rate (17%, 28%, and 7%). Rotterdam Prostate Cancer Risk Calculator 4-based stratification combined with 12-core TRUS-Bx ± MRI-TBx would have avoided 65% of biopsies and 68% of low-grade PCa while detecting an equal percentage of high-grade PCa (83%) compared with a TRUS-Bx all men approach (79%). ConclusionsAfter four repeated screens and ≥1 previous biopsies in half of men, a significant proportion of men aged ≥70 yr still harbor high-grade PCa. Upfront risk stratification and the combination of MRI and TRUS-Bx would have avoided two-thirds of biopsies and low-grade PCa diagnoses in our cohort, while maintaining the high-grade PCa detection of a TRUS-Bx all men approach. Further studies are needed to verify these results. Patient summaryProstate cancer screening reduces mortality but is accompanied by unnecessary biopsies and overdiagnosis of nonaggressive tumors, especially in repeatedly screened elderly men. To tackle these drawbacks screening should consist of an upfront risk-assessment followed by magnetic resonance imaging and transrectal ultrasound-guided biopsy.

Monitoring Tumor Volume in Patients With Prostate Cancer Undergoing Active Surveillance: Is MRI Apparent Diffusion Coefficient Indicative of Tumor Growth?

The purpose of this study was to measure longitudinal change in tumor volume of the dominant intraprostatic lesion and determine whether baseline apparent diffusion coefficient (ADC) and change in ADC are indicative of tumor growth in patients with prostate cancer undergoing active surveillance. The study group included 151 men (mean age, 68.1 ± 7.4 [SD] years; range, 50-83 years) undergoing active surveillance with 3D whole prostate, zonal, and tumor volumetric findings documented at endorectal MRI examinations performed at two time points (median interval, 1.9 years). Tumor (location confirmed at transrectal ultrasound or template biopsy) ADC was measured on the slice with the largest lesion. Twenty randomly selected patients had the measurements repeated by the same observer after a greater than 4-month interval, and the limits of agreement of measurements were calculated. Tumor volume increases greater than the upper limit of agreement were designated measurable growth, and their baseline ADCs and change in ADC were compared with those of tumors without measurable growth (independent-samples t test). Fifty-two (34.4%) tumors increased measurably in volume. Baseline ADC and tumor volume were negatively correlated (r = -0.42, p = 0.001). Baseline ADC values did not differ between those with and those without measurable growth (p = 0.06), but change in ADC was significantly different (-6.8% ± 12.3% for those with measurable growth vs 0.23% ± 10.1% for those without, p = 0.0005). Percentage change in tumor volume and percentage change in ADC were negatively correlated (r = -0.31, p = 0.0001). A 5.8% reduction in ADC indicated a measurable increase in tumor volume with 54.9% sensitivity and 77.0% specificity (AUC, 0.67). Tumor volume increased measurably in 34.4% of men after 2 years of active surveillance. Change in ADC may be used to identify tumors with measurable growth.

The Initial Experience of Trans-Rectal Ultrasound and Biopsy in Diagnosis of Carcinoma Prostate In Gezira Hospital For Renal Disease And Surgery (GHRDS)

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Prostate cancer prevalent cancer in males above sixty-five worldwide, this lead to the introduction of screening of the PSA and using of the transrectal ultrasound scanning, and sextant biopsy of the prostate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: To compare the accuracy of the Transrectal Ultrasound guided biopsy (TRUS/BX) in the diagnosis of prostate cancer in Gezira Hospital for Renal Diseases and Surgery (GHRDS), with specific considerations to the digital rectal examination (DRE) findings and prostate specific antigen (PSA) level. .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods&lt;/strong&gt;: This is a prospective, descriptive small-scale hospital based study. A total of 297 patients with clinically symptomatic enlarged prostate underwent transrectal ultrasound guided true cut needle biopsy of the prostate were studied in (GHRDS) in the period from June2006 to June2009. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The majority 188 (63.3%) of patients were between 50-70 years of age. Abnormal digital rectal examination (DRE) like obliteration of the median sulcus, and fixed mucosa revealed higher incidence of carcinoma prostate (CaP) with a significant value (p= 0.0000). PSA level showed significant relation (p= 0.0001) with the diagnosis of carcinoma prostate. Transrectal U/S findings well correlated to the histopathological results, where abnormal findings (like hypo-echoic lesions or calcifications and cysts) showed higher incidence of malignancy in 46 patients constitute 52.8% of the abnormal U/S findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and recommendations&lt;/strong&gt;: PSA level is highly sensitive but less specific in detection of prostate cancer. Normal DRE doesn’t exclude prostate cancer, fixed mucosa and obliterated median sulcus has the highest predictors of cancer prostate in DRE. Presence of calcifications and cyst on trans-rectal ultrasound has the highest liability for cancer prostate in compare to the other ultrasonic findings. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key words: &lt;/strong&gt;Prostate cancer, DRE, PSA level, TRUS/ BX (Transrectal ultra sound biopsy), sextant biopsy.&lt;/p&gt;

Confirmatory biopsy of men under active surveillance: extended versus saturation versus multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy

Objective: The aim of this study was to evaluate the detection rate for clinically significant prostate cancer (PCa) after multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS) fusion biopsy versus extended biopsy or saturation prostate biopsy (SPBx) in men enrolled on active surveillance (AS).Materials and methods: From May 2013 to January 2016, 100 men with very low-risk PCa were enrolled on AS. Eligible criteria were: life expectancy greater than 10 years, cT1c, prostate-specific antigen (PSA) below 10 ng/ml, PSA density less than 0.20 ng/ml², three or fewer unilateral positive biopsy cores, Gleason score (GS) equal to 6 and greatest percentage of cancer in a core 50% or lower. All patients underwent 3.0 T pelvic mpMRI before confirmatory transperineal extended biopsy (20 cores) and SPBx (median 30 cores) combined with mpMRI/TRUS fusion targeted biopsy (median four cores) of suspicious lesions [Prostate Imaging Reporting and Data System (PI-RADS) 3–5]. Clinically significant PCa was defined as the presence of at least one core with a GS of 4 or higher.Results: After confirmatory biopsy, 16 out of 60 (26.6%) patients showed significant PCa. Targeted biopsy of PI-RADS 4–5 versus PI-RADS 3–5 lesions diagnosed six out of 16 (37.5%) and 12 out of 16 (87.5%) significant PCa, respectively, with two false positives (5%). The detection rate for significant PCa was equal to 68.8% on mpMRI/TRUS fusion biopsy, 75% on extended biopsy and 100% on SPBx. mpMRI/TRUS targeted biopsy and extended biopsy missed five out of 16 (31.2%) and four out of 16 (25%) PCa, respectively.Conclusions: Although mpMRI may improve the diagnosis of significant PCa in men under AS, SPBx had a higher detection rate for clinically significant PCa.

Re: Diagnostic Accuracy of Multi-parametric Magnetic Resonance Imaging and Transrectal Ultrasound Biopsy in Prostate Cancer (PROMIS): A Paired Validating Confirmatory Study

Re: Diagnostic Accuracy of Multi-parametric Magnetic Resonance Imaging and Transrectal Ultrasound Biopsy in Prostate Cancer (PROMIS): A Paired Validating Confirmatory Study

High concordance of findings obtained from transgluteal magnetic resonance imaging - and transrectal ultrasonography-guided biopsy as compared with prostatectomy specimens.

To determine the utility of our transgluteal magnetic resonance imaging (MRI)-guided prostate biopsy approach. A total of 960 biopsy series, taken within the period of 1 year, were evaluated, including 301 MRI-guided and 659 transrectal ultrasonography (TRUS)-guided biopsies. The positivity rate and proportion of high grade cancers were significantly higher in MRI-guided than in TRUS-guided biopsies. Of 301 MRI-guided biopsies, 65.4% contained cancer while 57.2% of 659 TRUS biopsies contained cancer (P = 0.016). Gleason grade 3 + 3 = 6 disease was observed in 16.8% of 197 MRI-guided and in 36.1% of 377 TRUS-guided biopsies (P < 0.001). There was also a markedly higher quantity of cancer tissue in MRI-guided biopsies. In all cancers, the mean cancer surface area was 64.8 ± 51.6 mm2 in MRI-guided biopsies as compared with 23.0 ± 31.4 mm2 in non-MRI-guided biopsies (P < 0.001). With respect to the tissue quantity, superiority of MRI-guided biopsy was highest in Gleason grade 3 + 3 = 6 cancers (20.9 ± 27.9 vs 5.1 ± 10.2 mm2 ; P < 0.001) and in Gleason grade 3 + 4 = 7 cancers (59.7 ± 38.0 vs 17.7 ± 18.4 mm2 ; P < 0.001). Comparison of biopsy Gleason grades with findings in prostatectomy specimens was possible in 80 patients with MRI-guided and in 170 patients with non-MRI-guided biopsies. This comparison showed a very high but almost identical concordance of TRUS- and MRI-guided biopsies with the prostatectomy specimen findings. With both approaches, undetected high-risk cancers were present in ~10% of patients with low-risk biopsy results. A significant difference was observed, however, in the proportion of patients who had clinically insignificant cancers and who underwent surgery. The proportion of patients with Gleason grade 3 + 3 = 6 carcinoma in their prostatectomy specimen was 11.2% in the post-TRUS biopsy cohort, but only 2.5% in the post-MRI biopsy cohort (P = 0.021). MRI-guided transgluteal prostate biopsy has a high detection rate for high-risk carcinomas, while the risk of detecting clinically insignificant carcinomas appears to be reduced. This may by itself lead to a reduction of unnecessary prostatectomies. Overtreatment may be further avoided by better applicability of molecular testing to MRI-guided biopsies because of the excessive amount of tissue available for analysis, especially in patients with potential low-risk carcinomas.

Risk factors of complications after transrectal ultrasound guided prostate biopsy

Objective To explore the risk factors of complications after transrectal ultrasound guided prostate biopsy (TRUSPB). Methods 1 350 patients subject to TRUSPB between January 2011 and June 2016 were reviewed. The associations between biopsy complications and suspected factors were analyzed. Results There were 123 patients with complications in the 1350 patients after TRUSPB with the incidence of complications being 9.11%. Prostate volume >45 ml [odds ratio (OR)=7.916, 95% confidence interval (CI): 4.771-13.134], diabetes (OR=3.593, 95%CI: 1.680-7.682), urinary tract infection (OR=4.676, 95%CI: 1.875-11.661), prophylactic un-use of antibiotics (OR=0.015, 95%CI: 0.007-0.035) were related to the incidence of postoperative complications (χ2 values were 33.754, 12.279, 9.246, 17.911; P values were 0.000, 0.000, 0.001, 0.001). Age, biopsy core number, hypertension, prostatic cancer, prostate specific antigen (PSA) >20 ng/ml were not related to the incidence of postoperative complications (χ2 values were 0.348, 0.001, 2.587, 0.060, 0.116, 1.262; P values were 0.555, 0.980, 0.108, 0.806, 0.837). Conclusion Prostate volume >45 ml, diabetes and urinary tract infection were related risk factors of complications after TRUSPB, and prophylactic un-use of antibiotics was protective factor. Risk factors should be analyzed before TRUSPB, and some measures should be adopted to reduce complications. Key words: Prostate biopsy; Ultrasound; Prostatic diseases; Complications; Risk factors

MP33-20 THE SMARTTARGET BIOPSY TRIAL: A PROSPECTIVE PAIRED BLINDED TRIAL WITH RANDOMISATION TO COMPARE VISUAL-ESTIMATION AND IMAGE-FUSION TARGETED PROSTATE BIOPSIES

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2017MP33-20 THE SMARTTARGET BIOPSY TRIAL: A PROSPECTIVE PAIRED BLINDED TRIAL WITH RANDOMISATION TO COMPARE VISUAL-ESTIMATION AND IMAGE-FUSION TARGETED PROSTATE BIOPSIES Ian Donaldson, Sami Hamid, Dean Barratt, Yipeng Hu, Rachel Rodell, Barbara Villarini, Ester Bonmati, Paul Martin, David Hawkes, Neil McCartan, Ingrid Potyka, Norman Williams, Chris Brew-Graves, Caroline Moore, Mark Emberton, and Hashim Ahmed Ian DonaldsonIan Donaldson More articles by this author , Sami HamidSami Hamid More articles by this author , Dean BarrattDean Barratt More articles by this author , Yipeng HuYipeng Hu More articles by this author , Rachel RodellRachel Rodell More articles by this author , Barbara VillariniBarbara Villarini More articles by this author , Ester BonmatiEster Bonmati More articles by this author , Paul MartinPaul Martin More articles by this author , David HawkesDavid Hawkes More articles by this author , Neil McCartanNeil McCartan More articles by this author , Ingrid PotykaIngrid Potyka More articles by this author , Norman WilliamsNorman Williams More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , Caroline MooreCaroline Moore More articles by this author , Mark EmbertonMark Emberton More articles by this author , and Hashim AhmedHashim Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multi-parametric MRI targeted prostate biopsies can improve detection of clinically significant prostate cancer and decrease the diagnosis of clinically insignificant cancers. There is debate whether visual estimated targeting is sufficient or whether image-fusion software is required. We conducted an ethics committee approved, prospective, blinded, paired validating clinical trial of visual estimated targeted biopsies compared to non-rigid MR/US image-fusion using an academically developed fusion system (SmartTarget®). METHODS 141 men requiring targeted transperineal biopsies for accurate risk stratification were enrolled following written informed consent (August2014-September2016). Entry required prior trans-rectal ultrasound biopsy, a discrete lesion on mpMRI (PIRADS 3-5) and no previous prostate cancer treatment. All men underwent a targeted transperineal biopsy of a single lesion using visual estimation (3 cores) and image-fusion (3 cores). Two different urologists independently conducted the targeting strategies with each urologist assigned a strategy and order by randomised. Only one urologist was permitted to be present for each biopsy strategy and did not communicate with the other about any aspect of the procedure (blinded). 14 urologists of varying levels of experience participated. All were competent in transperineal targeting. UCL definition 2 clinically significant prostate cancer was used as the target condition for the primary outcome (>/= G3+4 and or MCCL >/= 4mm). RESULTS 129 men completed both biopsy strategies. Median age (IQR) was 65 years (58-70) and median PSA was 8.5ng/ml (5.6-12.1). 94 (72.8%) had clinically significant prostate cancer; 81/94 (86.2%) were identified on visual estimation targeting and 81/94 (86.2%) on image-fusion targeting. Fusion biopsy and visual estimation targeting each identified clinically significant cancers that the other missed, 13 and 13 respectively. We found no statistically significant difference between visual estimation and image-fusion (McNemar, p=1.00). CONCLUSIONS Our prospective, paired blinded trial demonstrates that there is no overall difference in detection of clinically significant prostate cancer between visual estimation and image-fusion targeted biopsies. Our results suggest that both techniques should be used together for optimal cancer detection. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e425 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ian Donaldson More articles by this author Sami Hamid More articles by this author Dean Barratt More articles by this author Yipeng Hu More articles by this author Rachel Rodell More articles by this author Barbara Villarini More articles by this author Ester Bonmati More articles by this author Paul Martin More articles by this author David Hawkes More articles by this author Neil McCartan More articles by this author Ingrid Potyka More articles by this author Norman Williams More articles by this author Chris Brew-Graves More articles by this author Caroline Moore More articles by this author Mark Emberton More articles by this author Hashim Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pathologic correlation of transperineal in-bore 3-Tesla magnetic resonance imaging-guided prostate biopsy samples with radical prostatectomy specimen.

To determine the accuracy of in-bore transperineal 3-Tesla (T) magnetic resonance (MR) imaging-guided prostate biopsies for predicting final Gleason grades in patients who subsequently underwent radical prostatectomy (RP). A retrospective review of men who underwent transperineal MR imaging-guided prostate biopsy (tpMRGB) with subsequent radical prostatectomy within 1 year was conducted from 2010 to 2015. All patients underwent a baseline 3-T multiparametric MRI (mpMRI) with endorectal coil and were selected for biopsy based on MR findings of a suspicious prostate lesion and high degree of clinical suspicion for cancer. Spearman correlation was performed to assess concordance between tpMRGB and final RP pathology among patients with and without previous transrectal ultrasound (TRUS)-guided biopsies. A total of 24 men met all eligibility requirements, with a median age of 65 years (interquartile range [IQR] 11.7). The median time from biopsy to RP was 85 days (IQR 50.5). Final pathology revealed Gleason 3+4=7 in 12 patients, 4+3=7 in 10 patients, and 4+4=8 in 2 patients. A strong correlation (ρ: +0.75, p<0.001) between tpMRGB and RP results was observed, with Gleason scores concordant in 17 cases (71%). 16 of the 24 patients underwent prior TRUS biopsies. Subsequent tpMRGB revealed Gleason upgrading in 88% of cases, which was concordant with RP Gleason scores in 69% of cases (ρ: +0.75, p<0.001). Final Gleason scores diagnosed by tpMRGB at 3-T correlate strongly with final RP surgical pathology. This may facilitate prostate cancer diagnosis, particularly in patients with negative or low-grade TRUS biopsy results in whom clinically significant cancer is suspected or detected on mpMRI.

634 - Prevalence and significance of fluoroquinolone-resistant bacteria carriage in patients undergoing trans rectal ultra-sonography prostate biopsy

To determine the prevalence of fluoroquinolone-resistant (FQR) bacteria carriage in patients undergoing transrectal ultrasound prostate biopsy (TRUS-Bx), and the relationship between the risk factors and FQR carriers as well as infections after prostate biopsy.Rectal swabs were obtained from 158 patients undergoing TRUS-Bx. The FQR organisms were isolated using selective media, and the antibiotic susceptibility pattern was determined. Moreover, after prostate biopsy, blood and urine samples were collected from patients with post-biopsy infection (PBI) during 30days of follow up.In total, 73 (46.2%) patients were positive for ciprofloxacin-resistant bacteria in rectal cultures. The most dominant isolates were Escherichia coli (95.9%). The antibiotic susceptibility patterns for the FQR rectal and clinical isolates showed high levels of resistance to ampicillin (94%) and trimethoprim-sulfamethoxazole (89.5%), while the resistance to amikacin, fosfomycin and imipenem remained very low. The multivariate analysis showed that previous use of FQs (OR, 2.54; 95% CI, 1.17-5.49; P = .019) and history of hospitalization (OR, 7.85; 95% CI, 2.075-29.744; P = .002) were significantly risk factors for the FQR carriage. On the other hand, the risk of PBI was higher among intestinal carriers of fluoroquinolone resistant bacteria compared with noncarriers, that this difference was statistically significant (24% versus 3.5%, P &lt; .001).The rates of PBI and hospitalization after TRUS-Bx were 12.5%, and 4.43%, respectively.An increase in the rectal FQR bacteria carriage is associated with elevated PBI, which strongly recommendsthe need for an appropriate prophylaxis to reduce infections in patients undergoing TRUS-Bx.

135 - Rectal culture-guided targeted antimicrobial prophylaxis significantly reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy – results of a cross-sectional study

135 - Rectal culture-guided targeted antimicrobial prophylaxis significantly reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy – results of a cross-sectional study