Clinical staging of prostate cancer: a computer‐simulated study of transperineal prostate biopsy

Abstract

biopsies, depending on the size of the prostate. Clinically threatening cancers were defined as having volumes of ≥ 0.5 mL or Gleason sum ≥ 7. RESULTSMethod A detected significantly more carcinomas than method B in both the autopsy and prostatectomy specimens (autopsy, 72 vs 51; prostatectomy, 50 vs 32, both P < 0.001). Method A also detected more clinically threatening cancers found at autopsy (38/40 vs 31/40, P = 0.008). Among autopsy patients with negative sextant biopsies whose disease was localized to one side, method A detected 72% and method B detected 29-43% ( P < 0.001). CONCLUSIONSThe results of this computer simulation show that 5-and 10-mm grid biopsies detect threequarters and a third, respectively, at autopsy, of patients with the disease localized to one side of the prostate, which may be useful when planning highly selective ablative treatments in the future.

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

“…18,19 When used with a 5-mm sampling frame, this approach can rule in and rule out prostate cancer foci of 0.5 cc and 0.2 cc volume with 90% certainty. 20 It was accepted that this approach is not yet widely available and carried a high burden on healthcare services because Evaluation of outcome and follow-up of its requirement for anesthesia, pathology processing, and reporting time.…”

Targeted focal therapy for prostate cancer: a review of the literature

“…Then the sections were transformed into a 3D computer model of the prostate simulating the transperineal saturation biopsy schemes at both 5 mm and 10 mm grid points. The study showed that compared to 10 mm grid point spacing, 5 mm spacing achieved a higher cancer detection rate and a higher detection rate of clinically nonthreatening tumors, and it adequately identified Gleason Grade 4 and 5 tumors [Crawford et al 2005]. This study showed that 5 mm grid spacing was most effective in detecting prostate cancer and should be used when performing transperineal mapping biopsies to further define the foci of prostate cancer before treating a patient with minimally invasive TFT and hemiablative techniques [Crawford et al 2005].…”

“…Some descriptions of transperineal biopsies describe the use of a Foley catheter (with aerated gel) in the urethra during the procedure, which can help identity the urethra [Crawford et al 2005]. Three days of oral antibiotic and alpha-blockers are given after the procedure [Barzell et al 2003].…”

“…Pre-procedure patient preparation includes a sodium bisphosphate and sodium phosphate enema (Fleet) the morning of and one hour before the procedure, as well as prophylactic antibiotics [Barzell et al 2003]. The patient must be under light general or IV sedation anesthesia for the procedure [Crawford et al 2005;Barzell et al 2003]. The patient is then placed in the dorsal lithotomy position with the scrotum elevated toward the abdomen [Barzell et al 2003].…”

“…Then one must move down a row and repeat until the prostate has been completely biopsied in all eight regions. Ultrasound guidance is used throughout the procedure to identify the prostate and surrounding anatomy, as well as the location of the biopsies [Crawford and Barqawi, 2007;Crawford et al 2005;Barzell et al 2003]. …”