Transrectal Ultrasound Prostate Biopsy Research Articles

Targeted Prostate Biopsy: How, When, and Why? A Systematic Review.

Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as "targeted prostate biopsy", "fusion prostate biopsy", "cognitive prostate biopsy", "MRI-guided biopsy", and "transrectal ultrasound prostate biopsy". Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life.

Micro-ultrasound for the detection of clinically significant prostate cancer in biopsy-naive men with negative MRI.

Despite a negative magnetic resonance imaging (MRI), some patients may still harbor clinically significant prostate cancer (csPCa, Gleason grade group ≥2). High-resolution micro-ultrasound (microUS) is a novel imaging technology that could visualize csPCa that is missed by MRI. This retrospective review included 1011 consecutive patients biopsied between September 2021 and July 2023 in Alberta, Canada. Among them were 103 biopsy-naive patients with negative MRI (Prostate Imaging Reporting & Data System [PI-RADS] ≤2) undergoing microUS-informed prostate biopsy (n=56) scored using Prostate Risk Identification Using Micro-ultrasound (PRI-MUS) or standard transrectal ultrasound prostate biopsy (n=47). The primary outcome was detection rate of csPCa stratified by biopsy technique and PRI-MUS score. MicroUS biopsy identified csPCa in 14/56 (25%) compared to standard biopsy in 8/47 (17%) (p=0.33). Patients with lesions PRI-MUS ≥3 had csPCa detected at a higher rate compared to patients with PRI-MUS ≤2 (42% vs. 16%, p=0.03). The csPCa detection rate was significantly different comparing patients with prostate-specific antigen (PSA) density <0.15 and PRI-MUS ≤2 compared to patients with PSA density ≥0.15 and PRI-MUS ≥3 (14% vs. 60%, p=0.02). MicroUS may aid in the detection of csPCa for patients with negative MRI.

Effects of the lesion size on clinically significant prostate cancer detection rates in PI-RADS category 3-5 lesions

IntroductionProstate cancer (PCa) ranks second among prevalent cancers in men, necessitating effective screening tools such as multiparametric magnetic resonance imaging (mpMRI) with the prostate imaging reporting and data system (PI-RADS) classification. This study explores the impact of lesion volume on clinically significant prostate cancer (csPCa) detection rates in PI-RADS 3–5 lesions, aiming to contribute insights into the underexplored relationship between lesion size and csPCa detection. Materials and methodsA retrospective analysis was conducted on data from 754 patients undergoing mpMRI-guided transrectal ultrasound (TRUS) prostate biopsy between January 2016 and 2023. Patients with PI-RADS 3, 4, and 5 lesions were included. Lesion size and PI-RADS categories were assessed through mpMRI, followed by MR fusion biopsy. ResultsOf the patients, 33.7%, 52.3%, and 14.1% had PI-RADS 3, 4, and 5 lesions, respectively. Lesion sizes correlated significantly with csPCa detection in PI-RADS 4 and 5 categories. For PI-RADS 3 lesions, no significant differences in csPCa rates were observed based on lesion size. However, in PI-RADS 4 and 5 groups, larger lesions showed higher csPCa rates. ConclusionThis study suggests that subgroup categorizations based on lesion volume could predict clinically significant PCa with high accuracy, potentially reducing unnecessary biopsies and associated overtreatment. Future research should further explore the relationship between lesion size and csPCa, clarifying discussions regarding the inclusion of systematic biopsies in diagnostic protocols.

Comparison of procedural anxiety and pain associated with conventional transrectal ultrasound prostate biopsy to magnetic resonance imaging-ultrasound fusion-guided biopsy: a prospective cohort trial.

Prostate cancer (PCa) diagnosis relies on biopsies, with transrectal ultrasound (TRUS) biopsies being common. Fusion biopsy (FB) offers improved diagnostic accuracy, but the pain and anxiety experienced by patients during biopsies is often overlooked. This study aims to compare pain and anxiety levels between standard TRUS-guided biopsy (STB) and systematic plus MRI/US fusion biopsy (STB + FB). The study involved adult men undergoing biopsies, receiving identical peri-procedural care, including 2% lidocaine jelly in the rectum and subsequent 1% lidocaine injections (10cc per side) into the prostate-seminal vesicle junction and prostatic apical areas bilaterally. The biopsy technique was chosen based on clinical and imaging findings. Pre- and post-biopsy anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire, categorized as mild (20-37), moderate (38-44), or severe (45-80). Post-biopsy pain was evaluated on a numerical rating scale, ranging from 0 to 10. Of the 165 patients, 99 underwent STB, and 66 underwent STB + FB. No significant differences were observed in age, race, prostate-specific antigen, prostate volume, or prior biopsies between the groups. The STB + FB group had more biopsy cores taken (16.2 vs. 12, p = 0.001) and a longer procedure time (23 vs. 10 min, p = 0.001). STB biopsy patients experienced lower post-procedural anxiety compared to STB + FB, with a mean difference of -7 (p = 0.001, d = 0.92). In the STB + FB group, 89% experienced severe post-procedural anxiety compared to 59% in STB (p = 0.002). There was no significant difference in post-procedural pain (p = 0.7). Patients with prior biopsies had significantly higher STAI(S) anxiety scores (p = 0.005), and the number of prior biopsies correlated with anxiety severity (p = 0.04) in STB + FB group. In summary, STB + FB group demonstrated higher post-procedural anxiety levels than the STB group, with no difference in pain levels. Additionally, patients with a history of repeat biopsies were more likely to exhibit higher STAI(S) anxiety scores.

Relationship between lower urinary tract symptoms (LUTS) and prostate cancer: A persistent myth

Background:The presence of lower urinary tract symptoms (LUTS) is described as an early symptom of prostate cancer in some patient guidelines; however, a statistical association has never been established.Methods:This study was conducted using a prospective electronic database at a single tertiary institution between January 2015 and November 2017. LUTS were assessed using the International Prostate Symptom Score (IPSS), and prostate cancer was graded according to the International Society of UroPathologists (ISUP) grading system. The association between IPSS and Grade Group was tested using parametric one-way analysis of variance (ANOVA) with post hoc analysis using Tukey’s honestly significant difference (Tukey’s HSD).Results:A total of 611 men attended the One-Stop Prostate Clinic (OSPC) and IPSSs were available for 557 men. Overall, 46% had mild LUTS (IPSS: 1–7), 38% had moderate LUTS (IPSS: 8–19) and 16% had severe LUTS (IPSS: 20–35). Almost 85% proceeded to have transrectal ultrasound (TRUS) prostate biopsies, and clinically significant prostate cancer (CSPC) was detected in 37% with mild LUTS, 35% with moderate LUTS and 42% with severe LUTS. Correlation between histopathology and IPSSs was assessed in all 78.8% of men who had IPSS data available and underwent prostate biopsies.Conclusion:This large series did not establish any correlation between LUTS and prostate cancer in men undergoing investigation for the suspicion of prostate cancer.Level of evidence:Not applicable

The prevalence and risk factors of upgrading of Gleason grade group between transrectal ultrasound prostate biopsy and prostatectomy specimens

The risk stratification of prostate cancer using Gleason grade group (GG), serum prostate-specific antigen (PSA), and T staging has an important role for appropriate treatment. In fact, the GG of biopsy was not the same as the prostatectomy specimen. The upgrading of GG has a significant risk of delay treatment. The study aims to evaluate the concordance of GG between biopsy and prostatectomy specimens and the factors of upgrading GG. Retrospectively reviewed data from January 2010 to December 2019, 137 patients underwent prostate biopsy and followed by prostatectomy. Patients' data include pathological reports, imaging reports, serum PSA, PSA density (PSAD), and free PSA were analyzed by univariate and multivariate analysis. The concordance between the pathology was found in 54 specimens (39.4%) with the upgrading of GG in the prostatectomy was 57 specimens (41.6%). Furthermore, the downgrading was 26 specimens (18.9%). Serum PSA >10 ng/ml (P 0.003), PSAD >0.2 ng/ml/cm3 (P 0.002), free/total PSA ratio (P 0.003), margin positive for malignancy (P 0.033), and extraprostatic involvement (P 0.039) were significantly related with upgrading at the univariate analysis. Only a PSAD >0.2 (P 0.014) was found to be an independent factor that is predictive of upstaging in multivariate analysis. The prevalence of upgrading of GG from prostate biopsy to radical prostatectomy is as high as the other study. The factor that related to upstaging of GG was PSAD. Therefore, additional tools for biopsy were required to enhance the accurate diagnosis and staging of prostate cancer.

Fluoroquinolone Resistance Level in Rectal Swab Taken Before Transrectal Ultrasound Prostate Biopsy

Fluoroquinolone Resistance Level in Rectal Swab Taken Before Transrectal Ultrasound Prostate Biopsy

Geographic Variation of Infectious Complications Following Prostate Biopsy in The United States: Results From a Population-Based Cohort of Privately Insured Patients

To elucidate regional trends of infectious complications following transrectal ultrasound prostate biopsy (TRUS-PB) from a national, privately-insured database. Using Market Scan, we identified all men who underwent TRUS-PB from 2010 to 2015. Infectious complications (UTI, prostatitis, sepsis) occurring 30 days after the prostate biopsy from emergency room (ER) visits or hospital admissions constituted the primary outcomes. We analyzed unadjusted and adjusted rates of infectious complications from ER visits and hospital admissions per 100 prostate biopsies by state. Multivariable logistic regression analyses were used to identify patient covariates associated with infectious complications. During the study interval, we identified 193,490 patients who underwent TRUS-PB. The mean age was 57.6 years (SD: 5.0). Over time the unadjusted national rates of infectious complications remained similar from 0.4 ER visits per 100 prostate biopsies in 2010 -0.2 in 2015 (P = 0.83), and 1.2 hospital admissions per 100 prostate biopsies in 2010 to 1.1 in 2015 (P= 0.58). Connecticut had the lowest unadjusted infectious complication rate per 100 biopsies at 0.64, whereas West Virginia had the highest at 2.34. Multivariable analysis revealed higher Elixhauser status and patient age were associated with higher odds of infectious complications (P<0.05). While rates of infectious complications attributable to prostate biopsies remain relatively stable, significant variation exists at the state level regarding this adverse outcome.

PD17-02 COST IMPLICATIONS OF INFECTIOUS COMPLICATIONS FOLLOWING PROSTATE BIOPSIES IN THE UNITED STATES

You have accessJournal of UrologyCME1 May 2022PD17-02 COST IMPLICATIONS OF INFECTIOUS COMPLICATIONS FOLLOWING PROSTATE BIOPSIES IN THE UNITED STATES Sharon White, Eric Ballon-Landa, Michael Bronsert, Boris Gershman, Peter Clark, Granville Lloyd, Jeffrey Morrison, Rodrigo Rodrigues-Pessoa, Marc Smaldone, Anessa Sax-Bolder, and Simon Kim Sharon WhiteSharon White More articles by this author , Eric Ballon-LandaEric Ballon-Landa More articles by this author , Michael BronsertMichael Bronsert More articles by this author , Boris GershmanBoris Gershman More articles by this author , Peter ClarkPeter Clark More articles by this author , Granville LloydGranville Lloyd More articles by this author , Jeffrey MorrisonJeffrey Morrison More articles by this author , Rodrigo Rodrigues-PessoaRodrigo Rodrigues-Pessoa More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Anessa Sax-BolderAnessa Sax-Bolder More articles by this author , and Simon KimSimon Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002555.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infectious complications following transrectal ultrasound prostate biopsies (TRUS-PB) represent a growing burden in the U.S. Understanding the health care costs attributable to these adverse outcomes following this common urologic procedure is essential but remains largely unknown. Herein, we describe the economic burden attributable to post TRUS-PB infectious complications from a population-based cohort of privately-insured patients. METHODS: From 2010 to 2015, we identified all patients who underwent an incident TRUS PB from MarketScan. Health care costs and patient out-of-pocket costs due to infectious complications requiring hospital admission and emergency room (ER) visits within 30 days of the TRUS-PB represented the primary outcome. Multivariable analyses were used to identify patient characteristics associated with higher health care and out-of-pocket costs. RESULTS: Overall, 193,490 patients underwent TRUS-PB and the mean age was 57.6 years (SD: 5.0). The rates of infectious complications requiring ER visits and hospital admissions were 0.4 and 1.2 per 100 prostate biopsies. Compared to patients who did not experience any infectious complications, patient admitted to hospital within 30 days had higher health care costs ($14,057 vs. $625; p < 0.001) and out-of-pocket costs ($80 vs. $9; p<.0001). Similarly, patients who required ER visits also had higher total health care costs compared to those who did not experience infectious complications ($141 vs. $4; p<.0001). Higher aggregate health care costs ($14,198 vs. $629; p<.0001) and out-of-pockets costs ($89 vs. $18; p<.0001) were observed for patients who sustained infectious complications. The total health care cost for infections was $38,234,689 On multivariable analyses, patients who had Elixhauser index defined comorbidities had total health care costs (p<0.001). CONCLUSIONS: Infectious complications following TRUS-PB are associated with significant economic burden to the health care system and patients. Efforts to reduce post TRUS-PB infectious complications can significantly improve value-based health care delivery. Source of Funding: This study was supported by the Schramm Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e336 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sharon White More articles by this author Eric Ballon-Landa More articles by this author Michael Bronsert More articles by this author Boris Gershman More articles by this author Peter Clark More articles by this author Granville Lloyd More articles by this author Jeffrey Morrison More articles by this author Rodrigo Rodrigues-Pessoa More articles by this author Marc Smaldone More articles by this author Anessa Sax-Bolder More articles by this author Simon Kim More articles by this author Expand All Advertisement PDF DownloadLoading ...

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 ...

MP43-06 COMPARING MRI/US FUSION TO STANDARD PROSTATE BIOPSY IN DETERMINING GRADE RECLASSIFICATION AT CONFIRMATORY BIOPSY IN A MULTI-INSTITUTIONAL ACTIVE SURVEILLANCE COHORT: A PENNSYLVANIA UROLOGY REGIONAL COLLABORATIVE (PURC) ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP43-06 COMPARING MRI/US FUSION TO STANDARD PROSTATE BIOPSY IN DETERMINING GRADE RECLASSIFICATION AT CONFIRMATORY BIOPSY IN A MULTI-INSTITUTIONAL ACTIVE SURVEILLANCE COHORT: A PENNSYLVANIA UROLOGY REGIONAL COLLABORATIVE (PURC) ANALYSIS David Strauss, Rohit Reddy, Matthew Loecher, Kaynaat Syed, John Danella, Serge Ginzburg, Laurence Belkoff, Jeffrey Tomaszewski, Edouard Trabulsi, Eric Singer, Bruce Jacobs, Jay Raman, Thomas Guzzo, Robert Uzzo, and Adam Reese David StraussDavid Strauss More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Matthew LoecherMatthew Loecher More articles by this author , Kaynaat SyedKaynaat Syed More articles by this author , John DanellaJohn Danella More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Laurence BelkoffLaurence Belkoff More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Eric SingerEric Singer More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Jay RamanJay Raman More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Adam ReeseAdam Reese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) has emerged as the optimal management of low-risk prostate cancer (CaP) patients, and relies on an accurate confirmatory biopsy to stratify disease risk. The literature is conflicting regarding whether multiparametric (mp) MRI/fusion biopsy improves detection of clinically significant cancers compared to standard 12-core trans rectal ultrasound (TRUS) at time of confirmatory AS biopsy. We aimed to analyze a prospectively maintained multi-institutional AS database with the intent to compare clinically significant reclassification rates between biopsy groups at confirmatory biopsy. METHODS: The Pennsylvania Urological Regional Collaborative (PURC) database, a prospectively maintained consortium CaP database, was retrospectively queried for all low-risk CaP men on AS. Patients were categorized by modality of confirmatory biopsy (either standard 12 core TRUS prostate biopsy or mpMRI targeted/ultrasound fusion prostate biopsy). The primary outcome of interest was grade group reclassification at the time of confirmatory biopsy. RESULTS: The study cohort included 469 low risk men on AS, with 339 (72%) undergoing standard 12-core TRUS confirmatory biopsy and 130 (28%) undergoing fusion confirmatory biopsy. There were no differences between groups at index biopsy, regarding demographic or disease characteristics. (Table 1) Clinically significant grade reclassification, defined as GG2 or greater, was seen on 42% (54) of mpMRI biopsies vs. only 22% (74) of standard biopsies (p < 0.001) (Table 2). CONCLUSIONS: The use of mp-MRI for AS confirmatory biopsy, compared to standard 12-core TRUS biopsy, improved the detection of clinically significant cancer. These findings suggest the value of MRI/US fusion biopsy to appropriately identify higher risk men on AS who may benefit from definitive treatment. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e742 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Strauss More articles by this author Rohit Reddy More articles by this author Matthew Loecher More articles by this author Kaynaat Syed More articles by this author John Danella More articles by this author Serge Ginzburg More articles by this author Laurence Belkoff More articles by this author Jeffrey Tomaszewski More articles by this author Edouard Trabulsi More articles by this author Eric Singer More articles by this author Bruce Jacobs More articles by this author Jay Raman More articles by this author Thomas Guzzo More articles by this author Robert Uzzo More articles by this author Adam Reese More articles by this author Expand All Advertisement PDF DownloadLoading ...

COMPARISON OF GRADING ACCURACY OF PROSTATE CANCER IN SAMPLES ACQUIRED BY A TARGETED AND SYSTEMIC PROSTATE BIOPSY.

All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading. To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy. We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological report. The undergrading was found in 17,7% (N=11) cases in the non-mpMRI group and in 12,0% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1. In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy.

Compаrative study: Efficacy and safety of MRI / ultrasound transperineal vs systematic transrectal prostate biopsy in patients with previous negative TRUS biopsy

Objective The aim of the study was to compare the efficacy and safety of magnetic resonance imaging / ultrasound-targeted transperineal prostate biopsy versus standard transrectal systemic biopsy, in detection of prostate cancer, in patients with evidence of previous negative systematic transrectal ultrasound prostate biopsy. Material and Methods From February 2019 to February 2021 in the Clinic of Endourology and SWL of the Military Medical Academy – Sofia, in 59 patients repeated prostate biopsy was performed after a previous negative systematic transrectal ultrasound-guided biopsy. In 35/59 patients in the group, MRI / ultrasound transperineal prostate biopsy was performed (group A), and in the remaining 24/59 patients a repeat systemic TRUS biopsy was performed (group B). The main indications for repeat prostate biopsy were persistent elevated PSA values, a finding on rectal digital examination, and / or a suspected area of prostate MRI. Results. Preoperative data were comparable in the two groups of patients, with no statistically significant differences. The mean value of PSA in group A was 17.27 ± 14.6 ng / ml, compared to 25.93 ± 24.19 ng / ml in group B, p = 0.264. MRI / ultrasound transperineal prostate biopsy revealed the presence of prostate cancer in 28 patients (80%) of the study group, compared to 8 patients (33.3%) in the group who underwent systematic TRUS biopsy, p = 0.001. The histopathological results of group A revealed the presence of low-grade prostate cancer in 15 patients (42.9%), compared to 13 patients (37.1%) in whom high-grade cancer was detected. The results show a statistically significant difference compared to patients in group B, where 3 patients (12.5%) showed low-grade prostate cancer, and 5 patients (20.8%) had a high-grade malignant process, p = 0.005. There was no statistically significant difference in intra- and postoperative complications in the two groups. Conclusion. Performing MRI / ultrasound targeted biopsy showed significant higher efficacy and identical safety in diagnosing a prostate neoplastic process compared to standard 12-core transrectal systemic biopsy in patients with previous negative systemic TRUS biopsy.

V14-11 MRI/US FUSION GUIDED PROSTATE BIOPSY USING A TRANSPERINEAL APPROACH: STEP-BY-STEP INSTRUCTIVE VIDEO ABSTRACT

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-11 MRI/US FUSION GUIDED PROSTATE BIOPSY USING A TRANSPERINEAL APPROACH: STEP-BY-STEP INSTRUCTIVE VIDEO ABSTRACT Eusebio Luna, Alberto Lopez-Prieto, Gloria Egui-Benatuil, Edward Gheiler, Ariel Kaufman, Dailianys Barrios, Farshad Shafizadeh, Michael Zachareas, and Fernando Bianco Eusebio LunaEusebio Luna More articles by this author , Alberto Lopez-PrietoAlberto Lopez-Prieto More articles by this author , Gloria Egui-BenatuilGloria Egui-Benatuil More articles by this author , Edward GheilerEdward Gheiler More articles by this author , Ariel KaufmanAriel Kaufman More articles by this author , Dailianys BarriosDailianys Barrios More articles by this author , Farshad ShafizadehFarshad Shafizadeh More articles by this author , Michael ZachareasMichael Zachareas More articles by this author , and Fernando BiancoFernando Bianco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric MRI has become an essential tool and is currently recommended by the AUA for the workup of men with suspected prostate cancer, the most common solid malignancy in the US.1-2 Office-based transrectal ultrasound prostate biopsies (TRUS) are still the standard in sampling the prostate.3 Notwithstanding its practicality, the transrectal approach harbors imprecision and a worse adverse events profile than a Transperienal approach.4 The perineum has been segregated to the operating room. However, we questioned this paradigm and develop a method to safely sample the prostate transperineally under local anesthesia in the office setting.5 Encouraging results led us to start an open-ended prospective registry NCT02381990 (clinicaltrials.gov), devised to evaluate outcomes of men treated with MRI/US- guided fusion in the office setting.6 Herein, we present a video-case showing a step-by-step execution of this technique. METHODS: This video shows a step-by-step transperineal MRI/US fusion guided prostate biopsy on a 75-year-old male with a PSA of 7.9 ng/ml and a PSA velocity > 1ng/ml/yr. He has no family history of prostate cancer and his digital rectal examination (DRE) was negative. An MRI was ordered and revealed several PI-RADS 3 regions of interest (ROI). The DICOM processing and incorporation into the fusion device was outsourced. On the procedure day, the fusion device was connected to the ultrasound and stepper with a grid. The biopsy was conducted as shown following the MRI plan. RESULTS: The procedure was performed successfully in 19 minutes. The patient reported a maximum pain of 3/10 and was discharged 20 minutes after its conclusion. He did not experience any adverse events. The biopsy was positive in one of the ROI. It was a Gleason 3+3 (GG1) prostate cancer in 50% of the core. Between 2014 and June 2020, we conducted 1,782 MRI/US Transperineal Biopsies under local anesthesia in the office setting at three different centers, a 91% (1,622) of these were MRI/US Fusion. Overall median biopsies time was 21 minutes (IQR 16,24). We abandoned transrectal biopsies in 2017. CONCLUSIONS: The purpose of this video is to show the tremendous benefits of such a feasible and convenient procedure. MRI/US fusion guided Prostate Biopsy using a Transperineal approach in an office-setting is reliable and reproducible. It deals with the “Harm” described by the US Task Force associated with prostate cancer screening, by thorough sampling in an office setting, providing accurate and precise information about the location of tumors to target, and opening a door for MRI/US-guided therapies in the office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1168-e1169 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eusebio Luna More articles by this author Alberto Lopez-Prieto More articles by this author Gloria Egui-Benatuil More articles by this author Edward Gheiler More articles by this author Ariel Kaufman More articles by this author Dailianys Barrios More articles by this author Farshad Shafizadeh More articles by this author Michael Zachareas More articles by this author Fernando Bianco More articles by this author Expand All Advertisement Loading ...

Prostate cancer with a large cystic lesion: Case Report

Prostate cancer is one of the most common malignancies in the world; however, it is rarely observed with cysts. Although prostate cysts are mostly benign, malignancies should not be ignored. A 66-year-old male presented with complaints of urinary retention and frequency. Regarding the results of clinical and paraclinical examination, elevated prostate-specific antigen (PSA) with a large cystic lesion was suspected. Initially, transrectal ultrasound prostate biopsy (TRUS BX), drainage, and cyst sclerotherapy with alcohol was performed. Pathology results confirmed the intra ductal carcinoma of prostate. The Three-Dimensional Conformal Radiation Therapy (3D CRT) and androgen deprivation therapy (ADT( were initiated. It is worth mentioning that his symptoms have improved now. In cases in which prostate is accompanied by cysts with high PSA, prostate cancer should not be ignored, and according to the guidelines, biopsy should be performed as needed. In the investigations of the prostate cysts causes, cancers are among the differential diagnosis, and therefore, malignancy should be a concern in the prostate cysts cases.

Topical antiseptic at time of transrectal ultrasound prostate biopsy is associated with fewer severe clinical infections and improves antibiotic stewardship.

BackgroundThe 2017 AUA White Paper on prevention of prostate needle biopsy (PNB) complications highlights an algorithm for reducing procedural related infections. The incorporation of topical rectal antiseptic (TRS) at time of transrectal PNB is listed as one such modality. We present data on over 1000 transrectal PNB procedures to determine the impact of TRS on 1) infectious complications and 2) use of augmented procedural antibiotics.MethodsThe records of 1181 transrectal PNB procedures performed over a 10-year period were reviewed. In 2013, TRS with either 10% povidone iodine or 4% chlorhexidine was more regularly incorporated into PNB procedures. Clinical and procedural factors were analyzed for association with post-procedure infections. Infectious complications outcomes were compared in patients receiving TRS (n = 566) versus those who had not (n = 615).ResultsA total of 990 men underwent 1181 transrectal PNB procedures. Median age of the cohort was 63 years with a median PSA of 7 ng/dL. Of them, 86% of the men were Caucasian, 28% had undergone at least one prior biopsy, 14% were diabetic, and 6% had prior hospitalization within 6 months of the procedure. Five hundred sixty-six patients (48%) received TRS at time of biopsy. Perioperative IV adjunctive antibiotics were used less frequently in patients receiving TRS (13.4% vs. 28.6%, p < 0.001). Furthermore, patients receiving TRS experienced lower rates of clinical infections (1.2% vs. 2.4%, p = 0.14), as well as lower likelihood of severe infections evidenced by decreased rates of hospital admission (0.5% vs. 2.3%, p = 0.013). Rectal vault bacteriology obtained before and after TRS was available in 180 men noting a 98.1% decrease in colony counts after local treatment.ConclusionsTRS at time of transrectal PNB was associated with decreased use of IV procedural antibiotics as well as decreased severity of infections post-biopsy. This simple technique enhances antibiotic stewardship while simultaneously improving quality outcomes of the procedure.

Towards real-time free-hand biopsy navigation.

Performing a transrectal ultrasound (TRUS) prostate biopsy is at the heart of the current prostate cancer detection procedure. With today's two-dimensional (2D) live ultrasound (US) imaging equipment, this task remains complex due to the poor visibility of cancerous tissue on TRUS images and the limited anatomical context available in the 2D TRUS plane. This paper presents a rigid 2D/3DUS registration method for navigated prostate biopsy. This allows continuous localization of the biopsy trajectory during the procedure. We proposed an organ-based approach to achieve real-time rigid registration without the need for any probe localization device. The registration method combines image similarity and geometric proximity of detected features. Additions to our previous work include a multi-level approach and the use of a rejection rate favouring the best matches. Their aim is to increase the accuracy and time performances. These modifications and their in-depth evaluation on real clinical cases and comparison to this previous work are described. We performed static and dynamic evaluations along biopsy trajectories on a very large amount of data acquired under uncontrolled routine conditions. The computed transforms are compared to a ground truth obtained either from corresponding manually detected fiducials or from an already evaluated registration method. All results show that the current method outperforms its previous version, both in terms of accuracy (the average error reported here is 12 to 17% smaller depending on the experiment) and processing time (from 20 to 60 times faster compared to the previous implementation). The dynamic registration experiment demonstrates that the method can be successfully used for continuous tracking of the biopsy location w.r.t the prostate at a rate that varies between 5 and 15Hz. This work shows that on the fly 2D/3DUS registration can be performed very efficiently on biopsy trajectories. This allows us to plan further improvements in prostate navigation and a clinical transfer.

644 Validation of The Prostate Imaging Reporting and Data System (PIRADS) Tool for Prostate Cancer Detection in A Contemporary British Cohort

Abstract Introduction The European Association of Urology (EAU) recommends multiparametric MRI (mpMRI) prior to prostate biopsy for investigation of prostate cancer (CaP). Specifically, the mpMRI should be reported using the Prostate Imaging Reporting and Data System (PIRADS) tool. Our study aims to externally validate the PIRADS tool over a multi-centre district general hospital. Method Retrospective review was performed on 104 consecutive patients who underwent mpMRI and subsequent cognitive transrectal ultrasound biopsy of prostate (CTRUSB) over an 18-month period. Collected mpMRI data was correlated with Gleason grading obtained through CTRUSB histology. Results On histology findings, a total of 64.4% patients (n = 67) were found to have prostate cancer with a mean PSA density (PSAD) of 0.48. Extremes of the PIRADS scoring tool showed a clear correlation. PIRADS 2 correlated to a 0% prostate cancer detection rate (PSAD 0.16), whereas PIRADS 5 correlated to 93.1% detection rate (PSAD 0.49). However, for PIRADS 3 and 4, prostate cancer detection rates were 49.8% (PSAD 0.25) and 50.9% (PSAD 0.18) respectively. Conclusions Our study substantiates the association of lesions scored as PIRADS 5 with prostate cancer detection. CTRUSB in PIRADS 2 lesions can be safely avoided. For PIRADS 3 and 4 lesions, PSAD should be considered before performing a biopsy.

A Prospective Study on the Efficacy of Cognitive Targeted Transrectal Ultrasound Prostate Biopsy in Diagnosing Clinically Significant Prostate Cancer.

PurposeWe present our study, done to identify the diagnostic yield of cognitive targeted biopsy using mpMRI data, to diagnose clinically significant prostate cancers, in a cohort of biopsy and treatment naive men.Materials and MethodsThis is a prospective, single institutional study, done from September 2018 to March 2020 in 75 biopsy naive men. The patients with 3, 4 and 5 PIRADS scores underwent mpMRI cognitive target biopsy (mpMRI CTB) followed by standard biopsy (SB) in the same setting by two different urologists. Diagnostic yield of biopsy cores, complications, and stage migration of Gleason’s grades was analyzed.ResultsOut of 75 patients, 34.6% had abnormal digital rectal examination (DRE), and the median serum PSA was 10.6 (4.5–20) ng/mL. Total MRI suspicious lesions were 163. Out of 1263 SB cores, 371 cores were positive for cancer (29.35%), and out of 326 mpMRI CTB cores, 120 were positive for cancer (36.8%) (P<0.0001). Histopathological examination (HPE) revealed 88%, 92%, and 100% clinically significant cancers in PIRADS 3, 4 and 5 lesions. SB and mpMRI CTB in combination have better cancer detection yield than either of the modality when used alone (P-<0.0001). Clavien-Dindo grade 1 and grade 4a complication were seen in 47 (62.6%) and three (4%) patients.ConclusionIn biopsy-naive men with suspected prostate cancer and equivocal DRE, the addition of pre-biopsy mpMRI detects greater numbers of people with clinically significant prostate cancer when compared with SB alone. Combining SB with mpMRI CTB has a superior diagnosing ability when compared with either of the biopsy modalities when used alone.

Prostate Cancer Risk Calculator Apps in a Taiwanese Population Cohort: Validation Study.

BackgroundMobile health apps have emerged as useful tools for patients and clinicians alike, sharing health information or assisting in clinical decision-making. Prostate cancer (PCa) risk calculator mobile apps have been introduced to assess risks of PCa and high-grade PCa (Gleason score ≥7). The Rotterdam Prostate Cancer Risk Calculator and Coral–Prostate Cancer Nomogram Calculator apps were developed from the 2 most-studied PCa risk calculators, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the North American Prostate Cancer Prevention Trial (PCPT) risk calculators, respectively. A systematic review has indicated that the Rotterdam and Coral apps perform best during the prebiopsy stage. However, the epidemiology of PCa varies among different populations, and therefore, the applicability of these apps in a Taiwanese population needs to be evaluated. This study is the first to validate the PCa risk calculator apps with both biopsy and prostatectomy cohorts in Taiwan.ObjectiveThe study’s objective is to validate the PCa risk calculator apps using a Taiwanese cohort of patients. Additionally, we aim to utilize postprostatectomy pathology outcomes to assess the accuracy of both apps with regard to high-grade PCa.MethodsAll male patients who had undergone transrectal ultrasound prostate biopsies in a single Taiwanese tertiary medical center from 2012 to 2018 were identified retrospectively. The probabilities of PCa and high-grade PCa were calculated utilizing the Rotterdam and Coral apps, and compared with biopsy and prostatectomy results. Calibration was graphically evaluated with the Hosmer-Lemeshow goodness-of-fit test. Discrimination was analyzed utilizing the area under the receiver operating characteristic curve (AUC). Decision curve analysis was performed for clinical utility.ResultsOf 1134 patients, 246 (21.7%) were diagnosed with PCa; of these 246 patients, 155 (63%) had high-grade PCa, according to the biopsy results. After confirmation with prostatectomy pathological outcomes, 47.2% (25/53) of patients were upgraded to high-grade PCa, and 1.2% (1/84) of patients were downgraded to low-grade PCa. Only the Rotterdam app demonstrated good calibration for detecting high-grade PCa in the biopsy cohort. The discriminative ability for both PCa (AUC: 0.779 vs 0.687; DeLong’s method: P<.001) and high-grade PCa (AUC: 0.862 vs 0.758; P<.001) was significantly better for the Rotterdam app. In the prostatectomy cohort, there was no significant difference between both apps (AUC: 0.857 vs 0.777; P=.128).ConclusionsThe Rotterdam and Coral apps can be applied to the Taiwanese cohort with accuracy. The Rotterdam app outperformed the Coral app in the prediction of PCa and high-grade PCa. Despite the small size of the prostatectomy cohort, both apps, to some extent, demonstrated the predictive capacity for true high-grade PCa, confirmed by the whole prostate specimen. Following our external validation, the Rotterdam app might be a good alternative to help detect PCa and high-grade PCa for Taiwanese men.