Transrectal Ultrasound-guided Research Articles

MP83-07 AFFECT ON EXPECTED AND PERCEIVED PAIN OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY IN ARABIC MEN GIVEN ARABIC MEDICAL INFORMATION

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety IV (MP83)1 Apr 2020MP83-07 AFFECT ON EXPECTED AND PERCEIVED PAIN OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY IN ARABIC MEN GIVEN ARABIC MEDICAL INFORMATION Brittany Milliner*, Joshua Palka, Nivedita Dhar, and Brian Allen Brittany Milliner*Brittany Milliner* More articles by this author , Joshua PalkaJoshua Palka More articles by this author , Nivedita DharNivedita Dhar More articles by this author , and Brian AllenBrian Allen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000975.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare providers in Metropolitan Detroit are seeing a growing number of Arabic-speaking migrants. Communication between Arabic-speaking patients and non-Arabic-speaking healthcare staff can be improved by using a professional interpreter and Arabic written medical information (AWMI). This study prospectively evaluated expected and actual pain levels before reading AWMI, after reading AWMI, and immediately after transrectal ultrasound guided (TRUS) prostate biopsy. METHODS: We prospectively analyzed records from 60 Arabic-only speaking/reading males aged 45-72 with elevated PSAwho underwent ambulatory TRUS prostate biopsy from a single urologist between January 2015 to December 2018. Pain was graded on an Arabic written Likert visual analog scale (Fig. 1) where 0 = no pain and 10 = excruciating pain. Patients completed the pain grading before and after reading the AWMI and after the prostate biopsy. The pain scores were evaluated for significance with the use of the Student t test and the Pearson correlation coefficient. RESULTS: The overall mean pain score was 4.74 ± 1.51 (range 2-9) before reading AWMI, 3.24 ± 1.57 (range 2- 8) after reading AWMI, and 2.18 ± 1.53 (range 1-7) after biopsy (P<.05) (Table 1). CONCLUSIONS: Muslim men have specific challenges in seeking healthcare based on Islamic teachings or social constructs. The use of AWMI in Arabic men may lower the amount of perceived pain of a prostate biopsy. Further research is needed to identify obstacles, improve access, and provide quality care for this population. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1258-e1258 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Milliner* More articles by this author Joshua Palka More articles by this author Nivedita Dhar More articles by this author Brian Allen More articles by this author Expand All Advertisement PDF downloadLoading ...

Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities.

Purpose:The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.Methods:We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.Results:A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.Conclusion:Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

Emergency attendances and hospitalisations for complications after transrectal ultrasound-guided prostate biopsies: a five-year retrospective multicentre study.

Transrectal ultrasound-guided (TRUS) prostate biopsy is an established procedure for diagnosis of prostate cancer. Complications after TRUS biopsy are not well reported in Hong Kong. This study evaluated the 5-year incidences of TRUS biopsy complications and potential risk factors for those complications. This was a retrospective review of biopsies performed from 2013 to 2017 in two local hospitals, using data retrieved from electronic medical records. The primary outcome was the occurrence of complications requiring either emergency attendances or hospitalisations within 30 days after biopsy. Potential risk factors were examined using multiple logistic regression analysis. In total, 1699 men were included (mean age ± standard deviation: 67 ± 7 years; median prostate-specific antigen level: 7.9 μg/L [interquartile range, 5.5-12.6 μg/L]); 4.3% had pre-biopsy bacteriuria. Overall, 5.7% and 3.8% of post-biopsy complications required emergency attendances and hospitalisations, respectively. Gross haematuria and rectal bleeding requiring emergency attendances developed in 2.1% and 0.4% of men; 0.8% and 0.4% required hospitalisations. Furthermore, 1.5% of men developed acute urinary retention requiring hospitalisations; 1.9% and 1.2% had post-biopsy infections requiring emergency attendances and hospitalisations, respectively, and 0.9% had urosepsis requiring hospitalisations. Prostate volume >48 cc was associated with an increased risk of post-biopsy retention (odds ratio 2.75, 95% confidence interval: 1.23-4.17). The rate of overall complications after TRUS biopsy was low. The most common complications requiring emergency attendances and hospitalisations were gross haematuria and acute urinary retention, respectively. Prostate volume >48 cc increased the risk of post-biopsy urinary retention.

Level of Prostate Cancer Diagnosis Using MRI-TRUS Fusion Biopsy in Patients with a Negative History of TRUS Biopsy

Background: Given the popularity of prostate specific antigen (PSA) testing in recent years, the number of patients undergoing diagnostic prostate biopsy has increased. The transrectal ultrasound-guided (TRUS) biopsy is considered as the gold standard for prostate cancer detection, although has a low sensitivity. Objectives: The current study aimed at enhancing prostate cancer diagnosis using MRI-TRUS fusion biopsy in patients with negative history of TRUS biopsy. Methods: In the current study, patients undergone TRUS prostate biopsy with benign results that were candidates for repeat biopsy were recruited. After making the preparations, patients underwent magnetic resonance imaging (MRI)-TRUS fusion biopsy. Gleason score, the number of involved cores, perineural invasion, perilymphovascular invasion, and the percentage of core involvement were recorded. Results: Of the 191 patients, 70 (36.6%) had positive biopsies. The frequency of non-detectable cancers by targeted biopsy based on the level of cancer risk showed that at the very high-risk level, five (29.4%) and at high-risk level, two (11.7%) subjects were not recognized. The mean Gleason score in targeted (7.47 ± 0.99) and random (7.13 ± 1.04) positive biopsies showed a significant difference between the two groups (P = 0.045). Targeted biopsies are better than random ones to detect high-risk (33.9% vs 29.2%, P = 0.013 respectively) and very high-risk cancers (45.3% vs. 41.5%, P = 0.05 respectively). Conclusions: The combination of both biopsy approaches is suggested to offer a reliable method with high rate of tumor detection.

Multiparametric magnetic resonance imaging (mpMRI) and PSA density for the prediction of reclassification among patients under active surveillance.

e16606 Background: To study the role of mpMRI and PSA density in predicting the likelihood of disease reclassification on re-biopsy and on final pathology among men with low-risk prostate cancer (PCa) enrolled in active surveillance (AS) protocol. Methods: In this IRB-approved prospective study, consecutive patients on AS for low-risk PCa (clinical stage cT1–T2a, Gleason score ≤6, serum PSA &lt; 10 ng/mL, no more than 3 positive cores on biopsy, and all biopsy cores with &lt; 50% of tumor involvement) from March 2015 to August 2017 were selected. The exclusion criteria were previous PCa treatment, contraindication to mpMRI or transrectal ultrasound-guided (TRUS) biopsy. All patients underwent mpMRI ≥3 months from initial biopsy and MRI-targeted TRUS-guided re-biopsy within 6-12 months. One experienced radiologist evaluated all mpMRI studies using the PI-RADS v2. The performance of mpMRI and PSA density for the prediction of reclassification on re-biopsy and final pathology was assessed. A single genitourinary pathologist reviewed all the final specimens who was blinded to the initial biopsy results. Results: A total of 154 patients were included in the final analysis. Among patients classified as PI-RADS ≤3, 11/69 (15.9%) were upgraded on re-biopsy whereas 65/85 (76.5%) were upgraded among those with PI-RADS 4 or 5 lesions. With regards to prostatectomy 7/49 (14.2%) patients classified as PI-RADS ≤3 were upgraded, while 42/49 (85.7%) were upgraded among those with PI-RADS 4 or 5. mpMRI sensitivity was 85.5% and specificity 74.4% on re-biopsy and 85.7% and in predicting upgrade on reclassification. Patients with PI-RADS 4 or 5 and PSA density &gt; 0.15 ng/mL/cm3 had 94.6% of chance of having clinically significant PCa, while patients with PI-RADS 1, 2 or 3 and PSA density ≤ 0.08 ng/mL/cm3 had only 4.2% probability. Conclusions: mpMRI and PSA density are significant tools for predicting severity reclassification on re-biopsy and final pathology among patients under active surveillance. Reclassification was low among patients with PI-RADS ≤3 and low PSA density. Overall, patients with PI-RADS 4 or 5 and PSA density &gt; 0.15 were almost invariably found to harbor significant prostate cancer.

MP13-12 ANALGESIC STRATEGY FOR TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY: A PROSPECTIVE STUDY

INTRODUCTION AND OBJECTIVES:Transrectal ultrasound-guided (TRUS) biopsy is the gold standard for prostate cancer diagnosis. This invasive procedure is generally associated with pain and discomfort....

Validated specific safety checklists for urological procedures can improve staff engagement and patient safety

Objective: Safety checklists have become an integral part of surgical practice. The aim of this quality improvement study was to identify and eliminate weaknesses within safety checklists for shockwave lithotripsy (SWL), flexible cystoscopy and transrectal ultrasound-guided (TRUS) biopsy of prostate. Subjects and methods: A root cause analysis was carried out into a case of incorrect side SWL treatment. Furthermore, we carried out a survey amongst staff regarding the suitability of our flexible cystoscopy and TRUS biopsy checklists. Following the introduction of new checklists, a satisfaction survey was sent to staff. Results: The initial staff survey regarding flexible cystoscopy and TRUS biopsy identified at least three irrelevant questions on the checklist, with a further six with low–moderate importance. A single checklist was created for flexible cystoscopy and TRUS biopsy, whilst a separate checklist was developed for SWL. The follow-up satisfaction survey rated the new checklists as ‘satisfactory’ (82%) or ‘very satisfactory’ (18%). Conclusion: Appropriate checklists, with questions relevant to the procedure being undertaken will lead to greater staff satisfaction and engagement. This may lead to better staff participation, which is likely to reduce errors. Level of evidence: 3.

Efficacy and safety of a combined anesthetic technique for transrectal prostate biopsy: a single center, prospective, randomized study.

IntroductionA transrectal ultrasound-guided (TRUS) biopsy is the gold standard for diagnosis of prostatic neoplasia. This exam is associated with pain and discomfort, and numerous methods of analgesia during this procedure have been described. There is still no consensus among urologists about the pain control technique that should be performed, even though the periprostatic basal nerve block is the most studied technique. The main objective of this study is to evaluate the benefit of adding local periapical prostatic anesthesia to the traditional periprostatic basal nerve block during TRUS biopsy.Material and methodsA total of 70 patients with indication for TRUS biopsy were enrolled in this study. Patients were randomized into 2 groups. Group 1 received a periprostatic basal nerve block. Group 2 received both periapical prostatic and periprostatic basal nerve blocks . The pain experienced during different moments of the procedure (introduction of the probe, anesthesia administration, removal of cores and 30 minutes after biopsy) was assessed using visual analog scales of one to ten. The rate of complications at 30 days post-biopsy was also assessed.ResultsThe difference in pain during the distinct moments of the TRUS biopsy was not significant between the two groups. There were no significant differences concerning age, level of total prostate-specific antigen (PSA) and prostate volume in both groups. There were also no statistically significant differences between the groups regarding the occurrence of complications and pathological findings.ConclusionsThe administration of concurent periprostatic basal and periapical nerve blocks has no significant benefits as compared to a periprostatic basal nerve block alone.

Location and Grade of Prostate Cancer Diagnosed by Transperineal Template-guided Mapping Biopsy After Negative Transrectal Ultrasound-guided Biopsy.

To determine the location and grade of prostate cancer diagnosed by transperineal template-guided mapping (TTMB) after negative transrectal ultrasound-guided (TRUS) biopsy. This analysis consisted of 1118 consecutive patients who underwent TTMB from January 2005 to August 2015. Eight hundred thirty-five underwent TTMB after at least 1 negative TRUS biopsy and 283 underwent TTMB as the first biopsy procedure. The study population was divided into cohorts based on the number of prior TRUS biopsy sessions (0, 1, 2, and ≥3). No patient underwent multiparametric magnetic resonance imaging. Differences in location and cancer grade detected on TTMB were evaluated as a function of the number of prior TRUS biopsies. Of the 1118 patients, 679 were diagnosed with prostate cancer. This included 208, 325, 104, and 42 patients who underwent 0, 1, 2, and ≥3 prior TRUS biopsies. The incidence of cancer detection on TTMB decreased as the number of prior TRUS biopsies increased (73.5% vs. 62.4% vs. 51.7% vs. 37.2%, P<0.001); however, it became increasingly likely that TTMB would detect anterior prostate only as the number of prior TRUS biopsies increased (P=0.007). Moreover, the incidence of high grade cancer (Gleason score ≥7) in the anterior gland increased with the number of previous TRUS biopsies. TTMB detected prostate cancer in over half of the patients with one or more negative TRUS biopsies. The majority of TTMB detected cancers were Gleason score ≥7. As the number of prior TRUS biopsies increased, there was a commensurate increase in the proportion of high-grade, anterior only disease.

MP26-07 IN-OFFICE FREEHAND TRANSPERINEAL TEMPLATE MAPPING BIOPSY PERFORMED UNDER LOCAL ANESTHESIA USING A NOVEL NEEDLE GUIDE: FEASIBLE, SAFE, AND EFFECTIVE FOR CANCER DETECTION

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2018MP26-07 IN-OFFICE FREEHAND TRANSPERINEAL TEMPLATE MAPPING BIOPSY PERFORMED UNDER LOCAL ANESTHESIA USING A NOVEL NEEDLE GUIDE: FEASIBLE, SAFE, AND EFFECTIVE FOR CANCER DETECTION Matthew Lee, Shaan Setia, Adam Cole, Michael Fenstermaker, Chandy Ellimoottil, Lindsey Herrel, John Wei, Srinivas Vourganti, and Arvin George Matthew LeeMatthew Lee More articles by this author , Shaan SetiaShaan Setia More articles by this author , Adam ColeAdam Cole More articles by this author , Michael FenstermakerMichael Fenstermaker More articles by this author , Chandy EllimoottilChandy Ellimoottil More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , John WeiJohn Wei More articles by this author , Srinivas VourgantiSrinivas Vourganti More articles by this author , and Arvin GeorgeArvin George More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sepsis following transrectal ultrasound-guided (TRUS) biopsy is rising with numerous strategies aimed at curbing its incidence. Transperineal prostate biopsy has negligible rates of sepsis but has traditionally been reserved for saturation sampling, required general anesthesia, and use of a brachytherapy grid/stepper. Additionally, the adequacy of modified 12-core transperineal template mapping biopsy (TMB) is debated. Herein, we describe our initial experience with completely in-office free-hand transperineal prostate biopsy (TPBx) performed under local anesthesia. METHODS A retrospective review was performed of patients who underwent TPBx at 2 institutions. TPBx was performed in lithotomy under TRUS guidance using a BK8848 biplanar probe after oral cephalosporin prophylaxis. Local anesthesia was administered via transperineal puncture and bolus delivery of anesthetic at the pelvic floor and through the endopelvic fascia anterior to the prostatic apex, bilaterally. The PrecisionPointTM device was used to access the left and right prostatic lobes to complete a modified barzell 12-core TMB. Patient characteristics and pathologic outcomes were collected and analyzed. RESULTS A total of 87 biopsies were performed with data available for 30 biopsies performed on protocol. Patient characteristics and pathologic data are summarized in Table 1. Mean age and PSA of the cohort were 63.4 years and 6.9ng/ml. Six men had a prior prostate cancer diagnosis and underwent biopsy on surveillance. The overall cancer detection rate (CDR) was 57% and clinically significant CDR (Gleason ≥7) was 33%. There were no complications noted within 30 days of biopsy. CONCLUSIONS Transperineal freehand prostate biopsy is effective for detection of prostate cancer. It is safe and well tolerated under local anesthesia, and can be performed in an office setting. Larger studies are required to validate this early experience. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e338 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Matthew Lee More articles by this author Shaan Setia More articles by this author Adam Cole More articles by this author Michael Fenstermaker More articles by this author Chandy Ellimoottil More articles by this author Lindsey Herrel More articles by this author John Wei More articles by this author Srinivas Vourganti More articles by this author Arvin George More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transrectal Ultrasound-guided Versus Transperineal Mapping Prostate Biopsy: Complication Comparison.

Herein, the authors compare morbidity in men who underwent both transrectal ultrasound-guided (TRUS) prostate biopsy and transperineal mapping biopsy (TPMB) at two institutions with extensive experience in both procedures. We also identified strategies and predictive factors to reduce morbidity for both procedures. In our study, 379 men from two institutions, of which 265 (69.9%) had a prior TRUS-guided biopsy, also had TPMB performed via a template with biopsies taken at 5-mm intervals. Men in the TRUS group had a median of 12 cores sampled whereas the TPMB group had 51.5 (range, 16-151). The median biopsy density was 1.1 core/cc prostate volume. Median age and prostate-specific antigen (PSA) level were 65 years (range, 34-86) and 5.5 ng/mL (range, 0.02-118). Of these men, 11 of 265 (4.2%) who had TRUS biopsy developed urinary tract infection compared with 3 of 379 (0.79%) of those with mapping biopsy. Infection was 14.8% in TRUS biopsy group with 13 or more cores versus 2.9% in those with 12 or less (OR, 5.8; 95% CI, 1.6-21.2; P = 0.003). No men developed retention after TRUS biopsy whereas 30 of 379 (7.9%) did following TPMB. Older age, larger prostate volume (PV), and higher core number were associated with retention. On linear regression only age (P = 0.010) and PV (P = 0.016) remained as significant associations. Men older than 65 years had 12.8% versus 3.9% (OR, 3.7; 95% CI, 1.6-8.4, P = 0.001) and PV greater than 42 cc had 13.4% versus 2.7% (OR, 5.7; 95% CI, 2.1-15.1) retention incidence. In the present study TPMB is rarely associated with infection (0.78%) but more commonly with urinary retention (7.9%). Men older than 65 years and with PV greater than 42 cc were at four to five times greater retention risk. Consideration should be given to discharging these men with a urinary catheter following TPMB.

A multicentre randomised controlled trial assessing whether MRI-targeted biopsy is non-inferior to standard transrectal ultrasound guided biopsy for the diagnosis of clinically significant prostate cancer in men without prior biopsy: a study protocol

IntroductionThe classical pathway for the diagnosis of prostate cancer is transrectal ultrasound-guided (TRUS) biopsy of the prostate initiated on the basis of a raised prostate-specific antigen (PSA). An alternative pathway...

New prostate cancer prognostic grade group (PGG): Can multiparametric MRI (mpMRI) accurately separate patients with low-, intermediate-, and high-grade cancer?

Our objective is to determine the accuracy of multiparametric MRI (mpMRI) in predicting pathologic grade of prostate cancer (PCa) after radical prostatectomy (RP) using simple apparent diffusion coefficient metrics and, specifically, whether mpMRI can accurately separate disease into one of two risk categories (low vs. higher grade) or one of three risk categories (low, intermediate, or high grade) corresponding to the new prognostic grade group (PGG) criteria. This retrospective, HIPAA-compliant, IRB-approved study included 140 patients with PCa who underwent 3T mpMRI with endorectal coil and transrectal ultrasound-guided (TRUS-G) biopsy before RP. MpMRI was used to classify lesions using a two-tier (low-grade/PGG 1 vs. high-grade/PGG 2-5) or a three-tier system (low-grade/PGG 1 vs. intermediate-grade/PGG 2 vs. high-grade/PGG 3-5). Accuracy of mpMRI was compared against RP for each system. The predictive accuracy of mpMRI using the two-tier system is higher than when using three-tier system (0.77 and 0.45, respectively). There were similar rates of undergrading between mpMRI and TRUS-G biopsy compared to RP (16% & 21%; respectively); rate of overgrading was higher for mpMRI vs. TRUS-G biopsy compared to RP (42% & 17%, respectively). When mpMRI and TRUS-G biopsy are combined, rate of undergrading is 1.4% and overgrading is 11%. MpMRI predictive accuracy is higher when using a two-tier vs. a three-tier system, suggesting that advanced metrics may be necessary to delineate intermediate- from high-grade disease. Rates of under- and overgrading decreased when mpMRI and TRUS-G biopsy are combined, suggesting that these techniques may be complementary in predicting tumor grade.

Transperineal Versus Transrectal MRI/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer

IntroductionTo evaluate the detection rate for clinically significant prostate cancer (PCa) of transperineal (TP) versus transrectal (TR) multiparametric (mp) magnetic resonance imaging (MRI)/transrectal ultrasound-guided (TRUS) fusion targeted biopsy. Patients and MethodsFrom January 2015 to January 2016, a total of 200 men (median age, 61 years) with negative digital rectal examination findings underwent repeat saturation TP prostate biopsy (SPBx; median 30 cores) for increasing or persistent elevated prostate-specific antigen values. Ten day before SPBx, all patients underwent 3.0 T pelvic mpMRI (Achieva 3T; Philips Healthcare Best, Netherlands). In the presence of mpMRI lesions suggestive of cancer (Prostate Imaging—Reporting and Data System [PI-RADS] score 4/5), targeted mpMRI/TRUS TR fusion guided biopsies (4 cores) and TP cognitive biopsies (4 cores) were added to SPBx. ResultsMedian prostate-specific antigen was 8.6 ng/mL, and mpMRI revealed a suspicious lesion in 95 (47.5%) of 200 cases. Overall, in 60 (30%) of 200 men, a clinically significant PCa was found, and in all cases, mpMRI was positive. SPBx, TR fusion, and mpMRI/TRUS TP cognitive targeted biopsy diagnosed 59 (98.3%), 40 (78.3%), and 56 (93.3%) clinically significant PCa, respectively. TR fusion versus TP targeted biopsy missed 12 versus 1 (P = .001) cancers of the anterior zone and 8 versus 3 (P = .12) cancers of the peripheric gland, respectively; moreover, PCa diagnosed by TR fusion versus TP targeted biopsy had a mpMRI lesion diameter and percentage of positive cores equal to 13 versus 10 mm and 33% versus 58% (P = .001), respectively. ConclusionmpMRI/TRUS TP cognitive targeted biopsy found a greater percentage of clinically significant PCa of the anterior zone compared to the mpMRI/TRUS TR fusion approach (93.3% vs. 25%; P = .0001).

The PROMIS study: A paired-cohort, blinded confirmatory study evaluating the accuracy of multi-parametric MRI and TRUS biopsy in men with an elevated PSA.

5000Background: Multi-parametric magnetic resonance imaging (MP-MRI) as a triage test might allow men to avoid unnecessary transrectal ultrasound-guided (TRUS) prostate biopsy since many men with a...

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

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

Transrectal ultrasound-guided prostate biopsy in Taiwan: A nationwide database study

BackgroundFor patients with an elevated prostate specific antigen (PSA) level or a suspected lesion detected by digital rectal examination, transrectal ultrasound-guided (TRUS) prostate biopsy is the standard procedure for prostate cancer diagnoses. In Taiwan, TRUS prostate biopsy has not been well-studied on a nationwide scale. This article aimed to study TRUS prostate biopsy in Taiwan and its related complications, according to the claims generated through the National Health Insurance (NHI) program. MethodsWe applied for access to claims from the NHI Research Database of Taiwan of all patients who visited the urology clinic during the period of 2006 to 2010. In the 5-year urology profile, we obtained all records, which included admission and ambulatory clinical records. The definition of TRUS biopsy included codes for ultrasound-guided procedure and for prostate puncture; other codes involving complications such as postbiopsy voiding difficulty, significant bleeding, or infection requiring treatment were also included. Risk factors included age, diagnosis of prostate cancer, hospitalization or nonhospitalization, and the Charlson Comorbidity Index (CCI; with a value of 0, 1, 2 or ≥ 3). Descriptive and comparative analyses were also performed. ResultsIn the 5-year urology profile, 12,968 TRUS biopsies performed of which 6885 were in-patient procedures and 6083 were ambulatory clinic procedures. After the procedures, 1266 (9.76%) biopsies were associated with voiding difficulty; 148 (1.14%) biopsies, with significant bleeding; and 855 (6.59%) biopsies, with infection that required treatment. The prostate cancer diagnosis rate was 36.02%. The overall biopsy-related mortality rate within 30 days was 0.25%, and the postbiopsy sepsis-related mortality rate was 0.13%. Age, diagnosis of cancer, hospitalization, and CCI value ≥ 1 were all significant factors in univariate analysis and multivariate analysis for postbiopsy voiding difficulty and severe infection. A diagnosis of cancer and a CCI value ≥ 2 were significant factors for significant bleeding after biopsy. Patients diagnosed as having prostate cancer had fewer bleeding complications after biopsy. ConclusionThe most frequent complication was postbiopsy voiding difficulty, followed by infection that required treatment and significant bleeding. The sepsis-related mortality rate was 0.13%. Significant risk factors for postbiopsy complications included age, diagnosis of prostate cancer, hospitalization, and the CCI value.

Transperineal biopsy prostate cancer detection in first biopsy and repeat biopsy after negative transrectal ultrasound-guided biopsy: the Victorian Transperineal Biopsy Collaboration experience.

To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate. VTBC was established through partnership between urologists performing transperineal biopsies of the prostate (TPB) at three institutions in Melbourne. Consecutive patients who had TPB, as first biopsy or repeat biopsy after previous negative transrectal ultrasound-guided (TRUS) biopsy, between September 2009 and September 2013 in the VTBC database were included. Data for each patient were collected prospectively (except for TPB before 2011 in one institution), based on the minimum dataset published by the Ginsburg Study Group. Univariate and multivariate analyses were used to identify factors predictive of cancer detection on TPB. In all, 160 patients were included in the study, of whom 57 had TPB as first biopsy and 103 had TPB as repeat biopsy after previous negative TRUS biopsies. The median patient age at TPB was 63 years, with the repeat-biopsy patients having a higher median serum PSA level (5.8 ng/mL for first biopsy and 9.6 ng/mL for repeat biopsy) and larger prostate volumes (40 mL for first biopsy, and 51 mL for repeat biopsy). Prostate cancer was detected in 53% of first-biopsy patients and 36% of repeat-biopsy patients, of which 87% and 81%, respectively, were clinically significant cancers, defined as a Gleason score of ≥7, or more than three positive cores of Gleason 6. Of the cancers detected in repeat biopsies, 75% involved the anterior region (based on the Ginsburg Study Group's recommended biopsy map), while 25% were confined exclusively within the anterior region; a lower proportion of only 5% of cancers detected in first biopsies were confined exclusively within the anterior region. Age, serum PSA level and prostate volume were predictive of cancer detection in repeat biopsies, while only age was predictive in first biopsies. TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant prostate cancer. It provides excellent sampling of the anterior region of the prostate, which is often under-sampled using the TRUS approach, and should be considered as an option for all men in whom a prostate biopsy is indicated.

MP48-08 EARLY OUTCOMES OF COMBINATION MRI-TARGETED AND SATURATION TRANS-PERINEAL BIOPSY IN RESTAGING LOW-RISK PROSTATE CANCER FOR ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Detection and Screening I1 Apr 2015MP48-08 EARLY OUTCOMES OF COMBINATION MRI-TARGETED AND SATURATION TRANS-PERINEAL BIOPSY IN RESTAGING LOW-RISK PROSTATE CANCER FOR ACTIVE SURVEILLANCE Kae Jack Tay, Kenneth Chen, Yan Mee Law, Henry Ho, John Yuen, and Christopher Cheng Kae Jack TayKae Jack Tay More articles by this author , Kenneth ChenKenneth Chen More articles by this author , Yan Mee LawYan Mee Law More articles by this author , Henry HoHenry Ho More articles by this author , John YuenJohn Yuen More articles by this author , and Christopher ChengChristopher Cheng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1682AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In low-risk prostate cancer, we investigate if a strategy of combination staging-biopsy (CSB) of robotic transperineal saturation biopsy (rTPB) and MRI-targeted biopsy (MRI-TB) better classifies these patients for treatment options. METHODS This IRB-approved, prospective study included men with low-risk prostate cancer (PSA of ≤ 10 ng/ml, Gleason score ≤ 6, clinically ≤T2a) diagnosed on conventional transrectal ultrasound-guided (TRUS) biopsy. Patients first underwent multiparametric-MRI of the prostate ≥ 6 weeks after initial TRUS biopsy. A single dedicated radiologist then marked and assigned a PIRADS score to each suspicious lesion on a 24-sector template grid of the prostate. Biopsies were performed via transperineal route under general anaesthesia with iSR'obot™ Mona Lisa, a robotic platform with maximal coverage of prostate using real-time 3D-ultrasound technology. Systematic rTPB was first performed by a surgeon blinded to the MRI findings. Next, the MRI positive sector was targeted with 6 biopsy cores by a second surgeon. Our primary outcome was upgrading of Gleason score at CSB compared to initial TRUS biopsy. The secondary outcome was proportion of upgrading at MRI-TB compared to rTPB. RESULTS The 15 Singaporean men included have a mean age of 65.5 years. The mean PSA at diagnosis was 6.6 ± 2.0 ng/ml and the mean prostate volume was 32.1 ± 13.4 cc. At rTPB, a mean of 26.5 ± 9.1 cores were taken per patient, with a mean biopsy intensity of 0.87 ± 0.17 cores/ml of prostate. A total of 52 sectors were positive on MRI, of which 17 were PIRADS 5, 23 were PIRADS 4 and 12 were PIRADS 3. On MRI-TB, 14 lesions were Gleason ≥7 and all were PIRADS 5. Overall, CSB up-classify 5 patients (33.3%) - 2 by MRI-TB alone, 1 by rTPB alone and 2 by both modalities. CONCLUSIONS CSB upgrades a third of our patients presumed to be low-risk by initial TRUS biopsy. MR-TB detects 80 % of these patients. In patient with PIRADS 5 score, MRI-TB detects all Gleason ≥7 cancers. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e597 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kae Jack Tay More articles by this author Kenneth Chen More articles by this author Yan Mee Law More articles by this author Henry Ho More articles by this author John Yuen More articles by this author Christopher Cheng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD38-08 PERFORMANCE OF IN-BORE MR-GUIDED TARGETED PROSTATE BIOPSY FOR DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER: A MULTICENTER STUDY

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 2015PD38-08 PERFORMANCE OF IN-BORE MR-GUIDED TARGETED PROSTATE BIOPSY FOR DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER: A MULTICENTER STUDY Ely Felker, Stephanie Lee-Felker, John Feller, Stuart May, Robert Princenthal, Martin Cohen, David Lu, Daniel Margolis, Grace Kim, and Steven Raman Ely FelkerEly Felker More articles by this author , Stephanie Lee-FelkerStephanie Lee-Felker More articles by this author , John FellerJohn Feller More articles by this author , Stuart MayStuart May More articles by this author , Robert PrincenthalRobert Princenthal More articles by this author , Martin CohenMartin Cohen More articles by this author , David LuDavid Lu More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Grace KimGrace Kim More articles by this author , and Steven RamanSteven Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2429AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the safety and efficacy of in-bore MR-guided prostate biopsy (MRGB). METHODS In this IRB approved, HIPAA-compliant study, MRGB for prostate cancer (PCa) detection was evaluated from 2009–2014 at three centers. Multiparametric prostate MR (mpMRI) was performed with or without endorectal coil, using: T2WI, DWI with ADC, and post-gadolinium DCE on 1.5 or 3T systems. DCE sequences were processed with commercial software (DynaCAD, InVivo). Tumor suspicious regions (TSR) were stratified according to modified PI-RADS criteria. Biopsy targets were classified as intermediate or high probability for PCa. MRGB was performed using an FDA-approved needle guide (DynaTRIM; InVivo, Milwaukee, Wi) and dedicated 18G biopsy gun. At biopsy, multishot T2WI was performed for localization. Yield of MRGB for PCa and clinically significant disease (CSD) (Gleason 3+4 or higher) were calculated. RESULTS 511 men (mean age 66.9 years, mean PSA 10.1 ng/mL) with 829 TSR underwent MRGB for: abnormal PSA in 384 (75%), active surveillance in 83 (16%), and suspected recurrence in 44 (9%). 238 men (47%) had one or more prior negative transrectal ultrasound-guided (TRUS) biopsies. PCa was detected in 261 men (51%) and 315 TSR (38%). Of all positive MRBGs, 263 (83%) yielded clinically significant disease. 79 men (33%) with at least one prior negative TRUS biopsy had PCa on MRGB. Complications occurred in four of 511 (1%) men and included three cases of urosepsis and 1 case of hematuria complicated by urinary obstruction. CONCLUSIONS In-bore MRGB is safe and effective for detection of clinically significant PCa. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e827 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ely Felker More articles by this author Stephanie Lee-Felker More articles by this author John Feller More articles by this author Stuart May More articles by this author Robert Princenthal More articles by this author Martin Cohen More articles by this author David Lu More articles by this author Daniel Margolis More articles by this author Grace Kim More articles by this author Steven Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...