Transrectal Ultrasound-guided Research Articles

Development and validation of a clinical nomogram to predict prostatic inflammation in men with lower urinary tract symptoms.

Prostatic inflammation is an important etiological component of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). The Prostatic Inflammation Nomogram Study (PINS) aimed to develop and validate a nomogram for predicting the presence of prostatic inflammation in men with LUTS. This non-interventional, cross-sectional, prospective study was conducted in six secondary/tertiary centers across Cyprus, Greece, Italy, Portugal, and Spain. Men (≥40 years) with BPH/LUTS scheduled to undergo prostatic surgery or transrectal ultrasound-guided (TRUS) prostate biopsy were included. Fifteen demographic and clinical participant characteristics were selected as possible predictors of prostatic inflammation. The presence of inflammation (according to Irani score) in the prostatic tissue samples obtained from surgery/TRUS biopsy was determined. The effect of each characteristic on the likelihood a prostate specimen demonstrated inflammation (classified by Irani score into two categories, 0-2 [no/minimal inflammation] or 3-6 [moderate/severe inflammation]) was assessed using multiple logistic regression. A nomogram was developed and its discriminatory ability and validity were assessed. In total, 423 patients (mean age 68.9 years) were recruited. Prostate volume ultrasound (PVUS) > 50 mL, history of urinary tract infection (UTI) treatment, presence of diabetes, and International Prostate Symptom Score (IPPS) Storage score were statistically significant predictors of Irani classification. Logistic regression demonstrated a statistically significant effect for leucocytes detected via urine dipstick, presence of diabetes, PVUS > 50 mL, history of UTIs, and higher IPSS Storage score for the odds of an inflammatory score category of 3-6 versus 0-2. The nomogram had a concordance index of 0.71, and good internal validity. The nomogram developed from PINS had good predictive ability and identified various characteristics to be predictors of prostatic inflammation. Use of the nomogram may aid in individualizing treatment for LUTS, by identifying individuals who are candidates for therapies targeting prostatic inflammation.

Targeted multiparametric magnetic resonance imaging/transrectal ultrasound-guided (mpMRI/TRUS) fusion prostate biopsy versus systematic random prostate biopsy: A comparative real-life study.

Patients with suspected prostate cancer usually undergo transrectal ultrasound-guided (TRUS) systematic biopsy, which can miss relevant prostate cancers and lead to overtreatment. The aim of this study was to evaluate the detection rate for prostate cancer in MR-guided targeted biopsy (TB) and systematic biopsy (SB) in comparison with mpMRI of the prostate. Three hundred and eight men who underwent mpMRI due to elevated PSA values between 2015 and 2020 were studied at university hospital Aachen, Germany. MRI-images were divided into cohorts with suspicious findings (PI-RADS ≥ 3) and negative findings (PI-RADS < 3). In patients with PI-RADS ≥ 3 TB combined with SB was performed. A part of this group underwent RP subsequently. In patients with PI-RADS < 3 and clinical suspicion SB was performed. In the PI-RADS ≥ 3 group (n = 197), TB combined with SB was performed in 194 cases. Three cases were lost to follow-up. Biopsy yielded 143 positive biopsies and 51 cases without carcinoma. TB detected 71% (102/143) and SB 98% (140/143) of the overall 143 carcinoma. Overall, 102 carcinomas were detected by TB, hereof 66% (67/102) clinically significant (Gleason ≥ 3+4) and 34% (35/102) clinically insignificant carcinoma (Gleason 3+3). SB detected 140 carcinomas, hereof 64% (90/140) csPCA and 36% (50/140) nsPCA. Forty-one of the overall 143 detected carcinoma were only found by SB, hereof 46% (19/41) csPCA and 54% (22/41) nsPCA. Tumor locations overlapped in 44% (63/143) between TB and SB. In 25% (36/143), SB detected additional tumor foci outside the target lesions. 70/143 patients subsequently underwent RP. The detection of tumor foci was congruent between mpMRI and prostatectomy specimen in 79% (55/70) of cases. Tumor foci were mpMRI occult in 21% (15/70) of cases. In the group with negative mpMRI (n = 111), biopsy was performed in 81 cases. Gleason ≥ 3+4 carcinoma was detected in 7% and Gleason 3+3 in 24% cases. There was a notable number of cases in which SB detected tumor foci that were mpMRI occult and could have been missed by TB alone. Therefore, additional systematic random biopsy is still required. A supplemental random biopsy should be considered depending on the overall clinical suspicion in negative mpMRI.

Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors.

Current prostate biopsy (PBx) protocol for prostate cancer (PCa) diagnosis is to perform systematic biopsies (SBx) combined with targeted biopsies (TBx) in case of positive MRI (i.e. PI-RADS ≥ 3). To assess the utility of performing SBx in combination with TBx, we determined the added value of SBx brought to the diagnosis of PCa according to their sextant location and MRI target characteristics. In our local prospectively collected database, we conducted a single-center retrospective study including all patients with a suspicion of PCa, who underwent transrectal ultrasound-guided (TRUS) prostate biopsies (PBx) with a prior MRI and a single lesion classified as PI-RADS ≥ 3. We have characterized the SBx according to their location on MRI: same sextant (S-SBx), adjacent sextant (A-SBx), ipsilateral side (I-SBx) and contralateral side (C-SBx). The added value of SBx and TBx was defined as any upgrading to significant PCa (csPCa) (ISUP ≥2). 371 patients were included in the study. The added value of SBx was 10% overall. Regarding the lesion location and the SBx sextant, the added value of SBx was: 5.1% for S-SBx, 5.4% for A-SBx, 4.9% for I-SBx and 1.9% for C-SBx. The overall added value of SBx was 6.8% for PI-RADS 3 lesions, 14% for PI-RADS 4 lesions and 6.7% for PI-RADS 5 lesions (p = 0.063). The added value of SBx for contralateral side was 1.9% (2/103), 3.1% (5/163) and 0% (0/105) for PI-RADS 3, PI-RADS 4 and PI-RADS 5 lesions, respectively (p = 0,4). The added value of SBx was lower when the number of TBx was higher (OR 0.57; CI 95% 0.37-0.85; p = 0.007). Our results suggest that the utility of performing SBx in the contralateral lobe toward the MRI lesion was very low, supporting that they might be avoided.

DWI CAPACITY IN PROSTATE CANCER DIAGNOSING

Relevance: Prostate cancer is one of the leading causes of cancer deaths in men worldwide. Transrectal ultrasound-guided (TRUS) prostate biopsy is the most important diagnostic step, without which a definitive diagnosis cannot be made. Despite this, TRUS-guided prostate biopsy has a high rate of false negatives and is often accompanied by various clinical complications. Multiparametric MRI (mpMRI) is now widely used in routine urological and oncological practice. An element of mpMRI is diffusion-weighted imaging (DWI), which is successfully used in detecting and localizing clinically significant prostate cancer.&#x0D; The study aimed to evaluate the DWI capacity in diagnosing prostate cancer.&#x0D; Methods: 52 patients, 48-86 years old, with suspected prostate cancer, underwent mpMRI. DWI sequences obtained using T2-weighted imaging (T2WI) were compared with each other and compared with the anatomical structure of the prostate. Suspicious prostate cancer sites were marked as regions of interest, for which an apparent diffusion coefficient (ADC) was calculated. A 12-point TRUS-guided biopsy confirmed the presence or absence of prostate cancer.&#x0D; Results: When analyzing quantitative measurements, ADC showed low values for cancer in the central gland (transitional zone and central zone) – 0.610±0.157×10-3 mm2/s, p=0.0001, and for cancer in the peripheral zone – 0.651±0.228×10-3 mm2/s, p=0.0004, compared to normal tissue. It was found that the highest sensitivity value (87.5%) is typical for ADC central gland, and the lower value for ADC peripheral zone is 75%. The highest specificity value (90.9%) was observed in ADC peripheral zone, and a lower value in ADC central gland – was 84.1%.&#x0D; Conclusion: DWI is an effective non-invasive method for detecting and localizing prostate cancer, providing a qualitative (visual) and quantitative assessment of prostate cancer.

DWI CAPACITY IN PROSTATE CANCER DIAGNOSING

Relevance: Prostate cancer is one of the leading causes of cancer deaths in men worldwide. Transrectal ultrasound-guided (TRUS) prostate biopsy is the most important diagnostic step, without which a definitive diagnosis cannot be made. Despite this, TRUS-guided prostate biopsy has a high rate of false negatives and is often accompanied by various clinical complications. Multiparametric MRI (mpMRI) is now widely used in routine urological and oncological practice. An element of mpMRI is diffusion-weighted imaging (DWI), which is successfully used in detecting and localizing clinically significant prostate cancer.&#x0D; The study aimed to evaluate the DWI capacity in diagnosing prostate cancer.&#x0D; Methods: 52 patients, 48-86 years old, with suspected prostate cancer, underwent mpMRI. DWI sequences obtained using T2-weighted imaging (T2WI) were compared with each other and compared with the anatomical structure of the prostate. Suspicious prostate cancer sites were marked as regions of interest, for which an apparent diffusion coefficient (ADC) was calculated. A 12-point TRUS-guided biopsy confirmed the presence or absence of prostate cancer.&#x0D; Results: When analyzing quantitative measurements, ADC showed low values for cancer in the central gland (transitional zone and central zone) – 0.610±0.157×10-3 mm2/s, p=0.0001, and for cancer in the peripheral zone – 0.651±0.228×10-3 mm2/s, p=0.0004, compared to normal tissue. It was found that the highest sensitivity value (87.5%) is typical for ADC central gland, and the lower value for ADC peripheral zone is 75%. The highest specificity value (90.9%) was observed in ADC peripheral zone, and a lower value in ADC central gland – was 84.1%.&#x0D; Conclusion: DWI is an effective non-invasive method for detecting and localizing prostate cancer, providing a qualitative (visual) and quantitative assessment of prostate cancer.

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia: Experience from a single institution in Malaysia

BackgroundFreehand transperineal prostate biopsy (TPPBx) using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer (PCa). It only requires the same equipment used for transrectal ultrasound-guided (TRUS) biopsy. Our study is the first in Malaysia to report this experience and its outcomes. We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia (LA). MethodsInstitutional review board approval was obtained from National Medical Research Register (NMRR ID-21-02052-VIL). We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022. Records were reviewed for patients’ characteristics, prostate volume, prostate-specific antigen (PSA) results, biopsy results and pain tolerability. Data was analyzed to determine PCa and clinically significant prostate cancer (csPCa) detection rate. LA was achieved using perineal skin infiltration and a periprostatic nerve block. The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide. The principles of the Ginsburg protocol were followed. Pain tolerability was assessed using a visual analog scale. ResultsA total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA. The mean age was 67.3 years, the median PSA was 14.2 ng/mL, and the median PSA density (PSAD) was 0.33 ng/mL/cc. The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc (area under the curve [AUC], 0.792; sensitivity, 87.5%; specificity, 69.2%). PCa was detected in 24 patients (43.6%), of whom 16 (29.1%) had csPCa. The median pain scores during LA infiltration and biopsy were four and two, respectively, which were significant different (P < 0.05). TPPBx exhibited an infection rate of zero. ConclusionThe PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series. The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.

Comparison of Gleason score of Prostate Cancer at Ultrasound/MRI Fusion Target Biopsy vs. Systematic Transrectal Ultrasound Guided Biopsy with Final Gleason score at Radical Prostatectomy

Purpose: To compare accuracy in predicting final Gleason Grade Group (GGG) of Prostate Cancer (PCa) of US/MRI fusion guided target (fBx) vs. systematic Transrectal Ultrasound-Guided (TRUS) biopsy, using histopathologic analysis at prostatectomy as the gold standard. Materials and methods: After obtaining IRB approval, we retrospectively reviewed records of patients who underwent Radical Prostatectomy (RP) from January 2014 through May 2019 with prior US/MRI fusion guided target or TRUS biopsy. The rates of upgrading (RP GGG &gt; BX GGG), downgrading (RP GGG &lt; BX GGG), and concordance (RP GGG = BX GGG) were compared between the fBx and TRUS groups. Age, PSA, PSA density, and prostate volume were also noted for all patients. Statistical analysis was utilized to assess the data. Results: A total of 348 men with complete clinical data were included in this study. The rate of downgrading and upgrading in the fBx group was less than in the TRUS biopsy group (14% vs. 19.6%, and 13.2% vs. 19.6%, respectively). The concordance rate was higher in the US-MR fBx group (72.9% vs. 60.7%, p &lt; 0.05)) across all GGG. Notably, lower rates of concordance were found for GGG 1 (24.1%) and GGG 4 (3.6%) in the TRUS Bx group. Patients who underwent US-MR fBx had higher average PSA (9.4 vs. 6.5 ng/ml), higher PSA density (0.3 vs. 0.2 ng/ml2), and lower prostate volume (31 vs. 42 cc). Additionally, biopsy results showed a lower rate of GGG 1 (3.1% vs. 13.2%) and a higher rate of GGG 5 (14.7% vs. 5.5%) in the US-MR fBx group. Conclusions: Target biopsy has a higher GGG concordance compared to TRUS biopsy (72.9% vs. 60.7%, p &lt; 0.05). In addition, there was less downgrading or upgrading of final PCa GGG in the fBx groups compared to TRUS Bx (14% vs. 19.6%, 13.2% vs. 19.6%, respectively). This finding may have important implications for treatment decisions.

Antimicrobial resistance profiles for bacteria isolated from rectal swabs in patients candidate for prostate biopsy

Objective: Infection is one of the common complications of post-prostate biopsy. Therefore, prophylaxis with fluoroquinolones and/or cephalosporins is recommended. We aimed to evaluate the prevalence of antibiotic-resistant bacteria isolated from rectal swabs in candidates for transrectal ultrasound-guided (TRUS) biopsy. The possible patient’s related risk factors attributing to resistance to antibiotics were also assessed. Methods: This cross-sectional study was performed on 126 male patients who were candidates for TRUS biopsy. Rectal swabs were collected and the samples were transferred to the laboratory in Amies transport medium during 2 hours and cultured on MacConkey agar with ciprofloxacin 1 mg/L and ciprofloxacin-resistant strains were identified. Kirby-Bauer disc diffusion method was used to determine the antibiotic susceptibility of the isolates. Results: In total, 59 bacterial isolates were obtained, which were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, respectively, in terms of frequency. They showed the lowest resistance to levofloxacin. Smoking was associated with positive culture results. Age was a factor with a significant effect on carrying ciprofloxacin-resistant strains. Conclusion: Ciprofloxacin resistance was high in almost all strains, but post-biopsy infectious complications were very low. Level of evidence: Not applicable

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 ...

Change from transrectal to transperineal ultrasound-guided prostate biopsy under local anaesthetic eliminates sepsis as a complication

Transrectal ultrasound-guided (TRUS) biopsy of the prostate is associated with increased risk of post-procedural sepsis with associated morbidity, mortality, re-admission to hospital, and increased healthcare costs. In the study institution, active surveillance of post-procedural infection complications is performed by clinical nurse specialists for prostate cancer under the guidance of the infection prevention and control team. To protect hospital services for acute medical admissions related to the coronavirus disease 2019 (COVID-19) pandemic, TRUS biopsy services were reduced nationally, with exceptions only for those patients at high risk of prostate cancer. In the study institution, this change prompted a complete move to transperineal (TP) prostate biopsy performed in outpatients under local anaesthetic. TP biopsies eliminated the risk of post-procedural sepsis and, consequently, sepsis-related admission while maintaining a service for prostate cancer diagnosis during the COVID-19 pandemic.

Cost-Effectiveness Analysis and Microsimulation of Serial Multiparametric Magnetic Resonance Imaging in Active Surveillance of Localized Prostate Cancer.

Many localized prostate cancers will follow an indolent course. Management has shifted toward active surveillance (AS), yet an optimal regimen remains controversial especially regarding expensive multiparametric magnetic resonance imaging (MRI). We aimed to assess cost-effectiveness of MRI in AS protocols. A probabilistic microsimulation modeled individual patient trajectories for men diagnosed with low-risk cancer. We assessed no surveillance, up-front treatment (surgery or radiation), and scheduled AS protocols incorporating transrectal ultrasound-guided (TRUS) biopsy or MRI based regimens at serial intervals. Lifetime quality-adjusted life-years and costs adjusted to 2020 US$ were used to calculate expected net monetary benefit at $50,000/quality-adjusted life-year and incremental cost-effectiveness ratios. Uncertainty was assessed with probabilistic sensitivity analysis and linear regression metamodeling. Conservative management with AS outperformed up-front definitive treatment in a modeled cohort reflecting characteristics from a multi-institutional trial. Biopsy decision conditional on positive imaging (MRI triage) at 2-year intervals provided the highest expected net monetary benefit (incremental cost-effectiveness ratio $44,576). Biopsy after both positive and negative imaging (MRI pathway) and TRUS biopsy based regimens were not cost-effective. MRI triage resulted in fewer biopsies while reducing metastatic disease or cancer death. Results were sensitive to test performance and cost. MRI triage was the most likely cost-effective strategy on probabilistic sensitivity analysis. For men with low-risk prostate cancer, our modeling demonstrated that AS with sequential MRI triage is more cost-effective than biopsy regardless of imaging, TRUS biopsy alone or immediate treatment. AS guidelines should specify the role of imaging, and prospective studies should be encouraged.

Prediction of recurrence from metabolites and expression of TOP2A and EZH2 in prostate cancer patients treated with radiotherapy.

The dual upregulation of TOP2A and EZH2 gene expression has been proposed as a biomarker for recurrence in prostate cancer patients to be treated with radical prostatectomy. A low tissue level of the metabolite citrate has additionally been connected to aggressive disease and recurrence in this patient group. However, for radiotherapy prostate cancer patients, few prognostic biomarkers have been suggested. The main aim of this study was to use an integrated tissue analysis to evaluate metabolites and expression of TOP2A and EZH2 as predictors for recurrence among radiotherapy patients. From 90 prostate cancer patients (56 received neoadjuvant hormonal treatment), 172 transrectal ultrasound-guided (TRUS) biopsies were collected prior to radiotherapy. Metabolic profiles were acquired from fresh frozen TRUS biopsies using high resolution-magic angle spinning MRS. Histopathology and immunohistochemistry staining for TOP2A and EZH2 were performed on TRUS biopsies containing cancer cells (n = 65) from 46 patients, where 24 of these patients (n = 31 samples) received hormonal treatment. Eleven radical prostatectomy cohorts of a total of 2059 patients were used for validation in a meta-analysis. Among radiotherapy patients with up to 11 years of follow-up, a low level of citrate was found to predict recurrence, p = 0.001 (C-index = 0.74). Citrate had a higher predictive ability compared with individual clinical variables, highlighting its strength as a potential biomarker for recurrence. The dual upregulation of TOP2A and EZH2 was suggested as a biomarker for recurrence, particularly for patients not receiving neoadjuvant hormonal treatment, p = 0.001 (C-index = 0.84). While citrate was a statistically significant biomarker independent of hormonal treatment status, the current study indicated a potential of glutamine, glutamate and choline as biomarkers for recurrence among patients receiving neoadjuvant hormonal treatment, and glucose among patients not receiving neoadjuvant hormonal treatment. Using an integrated approach, our study shows the potential of citrate and the dual upregulation of TOP2A and EZH2 as biomarkers for recurrence among radiotherapy patients.

Transrectal Ultrasound-Guided Biopsy Should Continue to Be a Standard of Care for the Detection of Prostate Cancer

For men choosing to screen for prostate cancer (PCa), biopsy remains critical for diagnosis. While transrectal ultrasound-guided (TRUS) biopsy has been the standard of care for many years, recent concerns regarding post-procedural infection have led to increased interest in prostatic sampling via the transperineal (TP) approach. However, TRUS biopsy features important patient-related and physician/practice-related advantages compared to the TP method, and there are several useful strategies to effectively mitigate infectious concerns. The benefits associated with TRUS biopsy, particularly patient comfort and efficient clinical workflow, are further accentuated by several key shortcomings associated with switching to the TP approach. Herein, we present an argument in favor of maintaining TRUS biopsy as standard practice, discussing significant topics including infectious complications, practice workflow and cost, cancer detection rates, and patient experience.

Cost-Effectiveness of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy Versus Systematic Transrectal Ultrasound-Guided Biopsy for Prostate Cancer Diagnosis: A Systematic Review

ObjectivesThis study aimed to systematically review the cost-effectiveness studies of multiparametric magnetic resonance imaging (mpMRI)-guided biopsy (MRGB) compared with systematic transrectal ultrasonography (TRUS)-guided biopsy for diagnosing prostate cancer (PCa). MethodsPubMed, Web of Science core collection, Embase and Scopus, and reference lists of the included studies were searched with no date and language restrictions through January 2020 for full economic evaluation studies (cost-effectiveness, cost-utility analysis, cost-benefit analysis) that assessed mpMRI and MRGB compared with systematic TRUS-guided biopsy or other sequential biopsy strategies in men undergoing initial prostate biopsy or men with previous negative prostate biopsy, with clinical suspicion of PCa based on abnormal prostate-specific antigen or digital rectal examination increase or both. Data were tabulated and analyzed using narrative synthesis. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ResultsFinally, 9 studies were included. All studies were conducted in high-income countries. All studies found that mpMRI and MRGB was cost-effective in the initial and before repeat biopsy in men with previous negative biopsy. The cognitive-targeted TRUS-guided biopsy was cost-effective in the initial biopsy (dominant or cost-effective at willingness-to-pay threshold of the countries); it was not evaluated for repeat biopsy in men. The direct in-bore magnetic resonance imaging (MRI)-guided biopsy was cost-effective for the initial biopsy (€323 per quality-adjusted life-year gained). The superiority of one of the targeted biopsy approaches (fusion, cognitive, or in-bore) over other approaches has not yet been established. ConclusionsThis study showed that pre-TRUS-guided biopsy MRI is more cost-effective than TRUS-guided biopsy alone. Furthermore, the use of MRI-ultrasound fusion targeted biopsy in the diagnosis of PCa in the initial biopsy and repeat biopsy and cognitive-targeted TRUS-guided biopsy in the initial biopsy is cost-effective.

Evaluation of Initial 24-core Transrectal Prostate Biopsy on the Detection of Significant Prostate Cancer and High-grade Prostatic Intraepithelial Neoplasia

Abstract Purpose: The purpose of the study was to assess the diagnostic value of an initial 24-sample transrectal ultrasound-guided (TRUS) prostate biopsy protocol compared to the 10-core technique. Materials and Methods: We retrospectively reviewed the prostate biopsy database of consecutive men undergoing prostate biopsies under local anesthesia using the 10 (Group A) and 24 (Group B) protocols. Men were stratified according to biopsy protocol and prostate-specific antigen (PSA) levels. Exclusion criteria were age = 75 years and PSA &gt;20 ng/mL. The Mann–Whitney U and Fisher’s exact test were used for statistical analysis. Results: Between November 2018 and August 2020, 169 men underwent TRUS prostate biopsies. Group A (10-cores) consisted of 105 (62.13%) men and Group B (24-cores) included 64 (37.86%) men. The overall prostate cancer detection rate was 41.05% and 36.72% in Groups A and B, respectively (P = 0.48). An overall 9.8% increase in Gleason 7 detection rate was found in Group B (P = 0.24). The high-grade prostatic intraepithelial neoplasia (HGPIN) detection rate in men with negative initial biopsies was 15.54% and 35.55% in Groups A and B, respectively (P &lt; 0.001). In patients with PSA &lt;10 ng/mL, the 24-core technique increased Gleason 7 detection rate by 13.4% (P = 0.16) and HGPIN by 23.4% (P = 0.0008), compared to the 10-core technique. The 24-core technique increased the concordance between needle biopsy and prostatectomy specimen compared to the 10-core technique (P &lt; 0.002). Conclusions: The initial 24-core prostate biopsy protocol did not show any benefit in the detection of prostate cancer compared to the 10-core technique. However, it improved the HGPIN detection and the correlation between biopsy results and radical prostatectomy Gleason score in men with lower PSA levels.

V14-12 PATIENT TOLERABILITY WITH OFFICE TRANSPERINEAL BIOPSY USING A REUSABLE NEEDLE GUIDE

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-12 PATIENT TOLERABILITY WITH OFFICE TRANSPERINEAL BIOPSY USING A REUSABLE NEEDLE GUIDE Stephen Wertheimer, Sara Perkins, Alex Borchert, Jeff Budzyn, Craig Rogers, and Amit Patel Stephen WertheimerStephen Wertheimer More articles by this author , Sara PerkinsSara Perkins More articles by this author , Alex BorchertAlex Borchert More articles by this author , Jeff BudzynJeff Budzyn More articles by this author , Craig RogersCraig Rogers More articles by this author , and Amit PatelAmit Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the most common urologic procedures is transrectal ultrasound-guided (TRUS) biopsy of the prostate. It is associated with a 1-5% risk of severe sepsis, despite the use of prophylactic antibiotics. Additionally, infectious complications appear to be increasing due to fluoroquinolone resistance. Recent studies have demonstrated the feasibility of transperineal (TP) prostate biopsy in the outpatient setting under local anesthetic (LA). We demonstrate the safety, efficacy, and tolerability our technique for performing TP biopsy under LA in the clinic setting using a reusable needle guide. METHODS: For biopsies, a biplanar ultrasound probe with an attached adjustable, reusable needle guide is used. A 17 gauge x 10 cm coaxial needle is attached to the needle guide. The skin is infiltrated, bilaterally, approximately 2 cm anterolateral to the anal verge with 1% lidocaine using a 25 gauge needle. A deeper prostatic block is then performed using a 20 gauge spinal needle, inserting it through the coaxial sheath. Administration of the anesthetic is delivered to the musculature of the pelvic floor, superficial-to-deep. Prostate samples are obtained using an 18 gauge x 25cm biopsy gun. All biopsies on a side can be obtained utilizing a single perineal skin puncture site. Patients who underwent office TP biopsy after May 2019 also completed a 10-item patient experience questionnaire regarding pain or discomfort experienced during the procedure. RESULTS: Our approach to office TP biopsy with reusable needle guide had a significantly lower utilization of prophylactic antibiotics compared to TRUS biopsy: 33.8% vs 99.5% (p<0.001), yet there were no admissions or infections, compared to 6 admissions (1.1%) for TRUS biopsy (p=0.01), of which 4 (0.7%) were for UTI or sepsis (p=0.04). The mean VAS score±SD for pain or discomfort caused by the overall office TP biopsy was 3.68±1.96. CONCLUSIONS: We demonstrate that office TP biopsy under LA with a reusable needle guide can be safely introduced with equivalent cancer detection rates whilst nearly eliminating the risk of urinary sepsis. This was achieved while also significantly reducing the use of prophylactic antibiotics. The procedure was well tolerated, with the most common complaint being local infiltration of anesthetic. We believe that office TP biopsy under LA can be performed with good patient tolerability, as almost 94% of patients were willing to undergo the procedure again. There is also the potential for reduction in overall cost with the use of a reusable needle guide. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1169-e1169 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Wertheimer More articles by this author Sara Perkins More articles by this author Alex Borchert More articles by this author Jeff Budzyn More articles by this author Craig Rogers More articles by this author Amit Patel More articles by this author Expand All Advertisement Loading ...

Integrative Machine Learning Prediction of Prostate Biopsy Results From Negative Multiparametric MRI.

Multiparametric MRI (mpMRI) is commonly recommended as a triage test prior to any prostate biopsy. However, there exists limited consensus on which patients with a negative prostate mpMRI could avoid prostate biopsy. To identify which patient could safely avoid prostate biopsy when the prostate mpMRI is negative, via a radiomics-based machine learning approach. Retrospective. Three hundred thirty patients with negative prostate 3T mpMRI between January 2016 and December 2018 were included. A 3.0 T/T2-weighted turbo spin echo (TSE) imaging (T2 WI) and diffusion-weighted imaging (DWI). The integrative machine learning (iML) model was trained to predict negative prostate biopsy results, utilizing both radiomics and clinical features. The final study cohort comprised 330 consecutive patients with negative mpMRI (PI-RADS < 3) who underwent systematic transrectal ultrasound-guided (TRUS) or MR-ultrasound fusion (MRUS) biopsy within 6 months. A secondary analysis of biopsy naïve subcohort (n=227) was also conducted. The Mann-Whitney U test and Chi-Squared test were utilized to evaluate the significance of difference of clinical features between prostate biopsy positive and negative groups. The model performance was validated using leave-one-out cross-validation (LOOCV) and measured by AUC, sensitivity, specificity, and negative predictive value (NPV). Overall, 306/330 (NPV 92.7%) of the final study cohort patients had negative biopsies, and 207/227 (NPV 91.2%) of the biopsy naïve subcohort patients had negative biopsies. Our iML model achieved NPVs of 98.3% and 98.0% for the study cohort and subcohort, respectively, superior to prostate-specific antigen density (PSAD)-based risk assessment with NPVs of 94.9% and 93.9%, respectively. The proposed iML model achieved high performance in predicting negative prostate biopsy results for patients with negative mpMRI. With improved NPVs, the proposed model can be used to stratify patients who in whom we might obviate biopsies, thus reducing the number of unnecessary biopsies. 3 TECHNICAL EFFICACY: Stage 2.

What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review

ObjectiveTo investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies.DesignSystematic review.Data sourcesPubMed and Embase were searched using a string combination with keywords/Medical...

Utilization of Multiparametric MRI of Prostate in Patients under Consideration for or Already in Active Surveillance: Correlation with Imaging Guided Target Biopsy.

This study sought to assess the value of multiparametric magnetic resonance image (mp-MRI) in patients with a prostate cancer (PCa) Gleason score of 6 or less under consideration for or already in active surveillance and to determine the rate of upgrading by target biopsy. Three hundred and fifty-four consecutive men with an initial transrectal ultrasound-guided (TRUS) biopsy-confirmed PCa Gleason score of 6 or less under clinical consideration for or already in active surveillance underwent mp-MRI and were retrospectively reviewed. One hundred and nineteen of 354 patients had cancer-suspicious regions (CSRs) at mp-MRI. Each CSR was assigned a Prostate Imaging Reporting and Data System (PI-RADS) score based on PI-RADS v2. One hundred and eight of 119 patients underwent confirmatory imaging-guided biopsy for CSRs. Pathology results including Gleason score (GS) and percentage of specimens positive for PCa were recorded. Associations between PI-RADS scores and findings at target biopsy were evaluated using logistic regression. At target biopsy, 81 of 108 patients had PCa (75%). Among them, 77 patients had upgrading (22%, 77 of 354 patients). One hundred and forty-six CSRs in 108 patients had PI-RADS 3 n = 28, 4 n = 66, and 5 n = 52. The upgraded rate for each category of CSR was for PI-RADS 3 (5 of 28, 18%), 4 (47 of 66, 71%) and 5 (49 of 52, 94%). Using logistic regression analysis, differences in PI-RADS scores from 3 to 5 are significantly associated with the probability of disease upgrade (20%, 73%, and 96% for PI-RADS score of 3, 4, and 5, respectively). Adding mp-MRI to patients under consideration for or already in active surveillance helps to identify undiagnosed PCa of a higher GS or higher volume resulting in upgrading in 22%.