Impact of operator expertise on transperineal free-hand mpMRI-fusion-targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicenter prospective learning curve

Abstract

Purpose Transperineal mpMRI-targeted fusion prostate biopsies (TPFBx) are recommended for prostate cancer diagnosis, but little is known about their learning curve (LC), especially when performed under local anaesthesia (LA). We investigated how operators’ and institutions’ experience might affect biopsy results. Methods Baseline, procedure and pathology data of consecutive TPFBx under LA were prospectively collected at two academic Institutions, from Sep 2016 to May 2019. Main inclusion criterion was a positive MRI. Endpoints were biopsy duration, clinically significant prostate cancer detection rate on targeted cores (csCDR-T), complications, pain and urinary function. Data were analysed per-centre and per-operator (with ≥ 50 procedures), comparing groups of consecutive patient, and subsequently through regression and CUSUM analyses. Learning curves were plotted using an adjusted lowess smoothing function. Results We included 1014 patients, with 27.3% csCDR-T and a median duration was 15 min (IQR 12–18). A LC for biopsy duration was detected, with the steeper phase ending after around 50 procedures, in most operators. No reproducible evidence in favour of an impact of experience on csPCa detection was found at operator’s level, whilst a possible gentle LC of limited clinical relevance emerged at Institutional level; complications, pain and IPSS variations were not related to operator experience. Conclusion The implementation of TPFBx under LA was feasible, safe and efficient since early phases with a relatively short learning curve for procedure time.

Enhancing Prostate Cancer Detection Accuracy in Magnetic Resonance Imaging–targeted Prostate Biopsy: Optimizing the Number of Cores Taken

“…In the first 100 biopsies, an operator might need to acquire an increased number of targeted cores, as improved detection of csPCa is achieved by taking four or five cores during this period [32] . In the context of previous studies, it has been documented that the learning curve typically levels off after completing approximately 50 cases [33] , [34] . There is also a learning curve for radiologists.…”