Multicenter transperineal MRI-TRUS fusion guided outpatient clinic prostate biopsies under local anesthesia

Jacewicz, Maciej; Günzel, Karsten; Rud, Erik; Lauritzen, Peter Mæhre; Galtung, Kristina Flor; Hinz, Stefan; Magheli, Ahmed; Baco, Eduard

doi:10.1016/j.urolonc.2020.11.009

Cited by 19 publications

(25 citation statements)

References 17 publications

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“…In this study, the overall CDR of anyPCa was 65% with 91% in PI-RADS 5 tumors when using transperineal TBs and image fusion under local anesthesia. These results are consistent with our previous multicenter study, which demonstrated 94% anyPCa in PI-RADS 5 tumors when using the same technique (8).…”

Section: Discussionsupporting

confidence: 93%

Cancer Detection Rates in Targeted Transperineal MRI-TRUS Elastic Fusion-guided Prostate Biopsies Performed Under Local Anesthesia

et al. 2021

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Background/Aim: The aim of this study was to evaluate the cancer detection rate (CDR) using magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal targeted biopsy (TB). Patients and Methods: We included 401 consecutive patients, of which 161 were biopsy-naïve. All underwent prebiopsy bi-parametric MRI; patients with positive MRI [prostate imaging reporting and data system (PI-RADS≥3)] underwent TB. Biopsy-naïve patients with positive MRI underwent TB and systematic biopsies (SBs). MRI-negative patients underwent SBs. Clinically significant prostate cancer (csPCa) was defined as ISUP ≥2. The added value of SB was defined as an upgrade from a negative biopsy or ISUP of 1 in TB to csPCa in SB. Results: The median (interquartile range) age was 69 (range=63-74) years, and PSA was 6.9 (range=4.5-11) ng/ml. The overall CDR was 65%, with csPCa occurring in 48%. In cases of PI-RADS 5, CDR was 91%, and csPCa was 77%. The added value of SB was 2%. Conclusion: Transperineal TB biopsies using MRI-TRUS fusion yield a high CDR.Multiparametric magnetic resonance imaging (mpMRI) may detect and localize clinically significant (cs) prostate cancer (PCa) with high precision (1, 2). Targeted transrectal biopsies using different navigation systems yield high cancer detection rates (CDRs) but are associated with significant infections (3-5). It is well known that transperineal prostate biopsies cause significantly fewer infections (6-8), but few studies have evaluated the performance of transperineal targeted biopsies (TBs) using image fusion. The aim of this study was to evaluate the CDR using MRI-transrectal ultrasound (TRUS) fusion-guided transperineal TB. Patients and MethodsPatients and inclusion. A total of 550 patients were prospectively included in a two-center randomized control study on the role of antibiotic prophylaxis when using transperineal TB with MRI-TRUS fusion. The results reported in this paper are based on 401 consecutive patients from Oslo University Hospital (OUH). The inclusion period was from November 2019 to March 2021. The study was approved by the Regional Committees for Medical and Health Research Ethics (2019/1266) and has been registered at ClinicalTrials.gov (NCT04146142). Written informed consent was obtained from all patients prior to inclusion. Biopsies were performed at the Department of Urology, OUH.Inclusion criteria included: Elevated PSA or PSA density >0.15 ng/ml 2 , pathological digital rectal exploration (DRE), patients under active surveillance (AS) scheduled for routine re-biopsy, suspicion of recurrence after external beam radiation treatment (EBRT), routine biopsy at one year after partial prostate ablation using high-intensity focused ultrasound (HIFU). Exclusion criteria included: A high risk of post-biopsy infection and an allergy to the study drug. Endpoints included: CDR of anyPCa and csPCa at TB, maximum cancer core length (MCCL), and added value of SB.MRI. Pre-biopsy MRI of the prostate was performed in all patients. At OUS, we used a 1.5T AvantoFit...

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Section: Discussionsupporting

confidence: 93%

Cancer Detection Rates in Targeted Transperineal MRI-TRUS Elastic Fusion-guided Prostate Biopsies Performed Under Local Anesthesia

et al. 2021

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“…We found 39 retrospective studies, 46 prospective studies, and 13 RCTs where periprocedural antibiotics were administered [12] , [13] , [14] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [67] , [68] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , …”

Section: Evidence Synthesisunclassified

“…We found ten retrospective studies, three prospective studies, and one RCT where antibiotic prophylaxis was not administered [10] , [11] , [12] , [13] , [14] , [17] , [34] , [46] , [66] , [69] , [87] , [91] , [100] , [113] . The study cohorts included 43–2192 men.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Proponents of this cite improved antibiotic stewardship as well as the elimination of antibiotic-related adverse events as the rationale for their view. Indeed, there is evidence of safely foregoing prophylactic antibiotics with transperineal prostate biopsy [10] , [11] , [12] , [13] , [14] . It is worth acknowledging, however, that much of the available data come from single-arm cohort studies without a comparison with the use of periprocedural antibiotics.…”

Section: Introductionmentioning

confidence: 99%

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Role of Prophylactic Antibiotics in Transperineal Prostate Biopsy: A Systematic Review and Meta-analysis

Basourakos

Alshak

Lewicki

et al. 2022

European Urology Open Science

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“…59 To further mitigate this, local anaesthetic TP biopsies are being employed such as PrecisionPoint (Perineologic, Cumberland, MD) 60 or CamPROBE, 61 which can simplify the biopsy process and reduce the number of access points to one or two per side and can be performed within the setting of outpatient clinics. LA-TP biopsies offer equal cancer detection rates 62 whilst achieving lower incidence of post-operative infection, 63 and are well tolerated by patients 53,64 although there is ongoing research into the best technique for delivering the anaesthetic. 65 Statistical analysis also highlights the cost savings of clinic-based LA-TP approaches.…”

Section: Introductionmentioning

confidence: 99%

Optimal biopsy approach for detection of clinically significant prostate cancer

Ippoliti

Fletcher

Orecchia

et al. 2021

The British Journal of Radiology

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Prostate cancer (PCa) diagnostic and therapeutic work-up has evolved significantly in the last decade, with pre-biopsy multiparametric MRI now widely endorsed within international guidelines. There is potential to move away from the widespread use of systematic biopsy cores and towards an individualised risk-stratified approach. However, the evidence on the optimal biopsy approach remains heterogeneous, and the aim of this review is to highlight the most relevant features following a critical assessment of the literature. The commonest biopsy approaches are via the transperineal (TP) or transrectal (TR) routes. The former is considered more advantageous due to its negligible risk of post-procedural sepsis and reduced need for antimicrobial prophylaxis; the more recent development of local anaesthetic (LA) methods now makes this approach feasible in the clinic. Beyond this, several techniques are available, including cognitive registration, MRI–Ultrasound fusion imaging and direct MRI in-bore guided biopsy. Evidence shows that performing targeted biopsies reduces the number of cores required and can achieve acceptable rates of detection whilst helping to minimise complications and reducing pathologist workloads and costs to health-care facilities. Pre-biopsy MRI has revolutionised the diagnostic pathway for PCa, and optimising the biopsy process is now a focus. Combining MR imaging, TP biopsy and a more widespread use of LA in an outpatient setting seems a reasonable solution to balance health-care costs and benefits, however, local choices are likely to depend on the expertise and experience of clinicians and on the technology available.

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Multicenter transperineal MRI-TRUS fusion guided outpatient clinic prostate biopsies under local anesthesia

Cited by 19 publications

References 17 publications

Cancer Detection Rates in Targeted Transperineal MRI-TRUS Elastic Fusion-guided Prostate Biopsies Performed Under Local Anesthesia

Cancer Detection Rates in Targeted Transperineal MRI-TRUS Elastic Fusion-guided Prostate Biopsies Performed Under Local Anesthesia

Role of Prophylactic Antibiotics in Transperineal Prostate Biopsy: A Systematic Review and Meta-analysis

Optimal biopsy approach for detection of clinically significant prostate cancer

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