Re-biopsy of the Prostate Using a Stereotactic Transperineal Technique

Moran, Brian; Braccioforte, Michelle H.; Conterato, D.J.

doi:10.1016/j.juro.2006.06.030

Cited by 64 publications

(38 citation statements)

References 19 publications

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“…Standard transrectal prostate biopsy strategies have been developed to improve cancer detection but not to accurately locate or stage prostate tumors. To better characterize cancer location, many different techniques such as image guidance with color Doppler ultrasonography or MRI, transrectal saturation biopsies and perineal mapping biopsies are under evaluation (24)(25)(26)(27). Sextant biopsy protocols are insufficient to correctly characterize the cancer and some tumors may have been underestimated (28).…”

Section: Commentsmentioning

confidence: 99%

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

et al. 2011

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Purpose: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). Materials and Methods: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA ≤ 10 ng/mL, ≤ 3 positive biopsies with only 1 lobe involved, clinical stage ≤ T2a, Gleason score ≤ 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm (R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. Results: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. Conclusions: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate longterm cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.

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Section: Commentsmentioning

confidence: 99%

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

et al. 2011

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Section: Transrectal Versus Transperineal Biopsymentioning

confidence: 99%

“…Many studies have demonstrated that the apical region in general and the apex in particular have a significantly higher incidence of cancer than the rest of the prostate gland. [40,44] In our study at MDACC, we used transperineal saturation biopsy in patients who had failed primary therapy (radiation and/ or brachytherapy); the detection rate in treated and untreated patients was 58.82% and 41.17%, respectively. Abdollah et al [45] conducted a comparison between the 2 approaches using 472 patients where 70% had undergone transrectal biopsies and 30% had undergone trasperienal biopsies; the researchers found no difference in the detection rate between the approaches (31.4% versus 25.7%; p=0.3).…”

Section: Transrectal Versus Transperineal Biopsymentioning

confidence: 99%

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When prostate cancer remains undetectable: The dilemma

Mustafa

Pisters

2015

Turkish Journal of Urology

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Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist.Keywords: Prostate; prostate biopsy; prostate cancer History of prostate biopsy (PBx)Watanabe et al. [1] first introduced the use of transrectal ultrasound-guided (TRUSG) biopsy into the armamentarium of prostate cancer (PCa). Hodge et al. [2] reported on the efficacy of sextant biopsy under TRUS guidance for PCa detection. Initially, only ultrasonically detected hypoechoic areas were sampled. [3,4] In 1995, Stamey et al. [5] suggested that biopsy should be obtained from a more lateral location to better sample the anterior horn of the peripheral zone. Similarly, Norberg et al. [6] noticed that the second set of sextant biopsies performed immediately after the first set increased the PCa detection rate by as much as 30%. These findings prompted investigators to seek alternative biopsy schemes with an increased number of biopsy cores and/or sampling of the lateral peripheral zones for improved PCa detection. [7][8][9][10][11][12][13][14][15] Mc Neal et al. [16] provided the ground for better sampling of peripheral zones with special attention to the anterior horn. These modifications related to the total number of cores and the localization of biopsies improved the PCa detection rate. Extended biopsy schemeUzzo et al. [17] and Karakiewcz et al. [18] were the first to demonstrate an increase in the PCa detection rate in proportion to the number of biopsy cores obtained. Their findings provided the foundation for extended PBx where at least 10 cores are taken. Chen et al. [19] examined various biopsy schemes to define the approach associated with the highest PCa detection rate. They suggested that...

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“…9,10,24 Another possibility is creating mathematical models that predict the exact location of the needle and create a biopsy template. 25 Such mapping reduces the possibility of mapping inaccuracy because of needle displacement by deflection or by deformation of tissues.…”

Section: The Importance Of Mapping Biopsiesmentioning

confidence: 99%

Prostate Biopsy in Selecting Candidates for Hemiablative Focal Therapy

Tsivian

Hruza²,

Mouraviev³

et al. 2010

Journal of Endourology

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Focal therapy (FT) for the management of clinically localized prostate cancer (PCa) is growing from a concept to reality because of increased interest of both patients and physicians. Selection protocols, however, are yet to be established. We discuss the role of prostate biopsy in candidate selection for FT and highlight the different strategies and technical aspects of the use of prostate biopsy in this setting. In our opinion, prostate biopsy plays a major role in the selection process and tailoring appropriate treatment strategy to the patient. FT necessitates dedicated biopsy schemes that would reliably predict the extent, nature, and location of PCa in selected patients. Currently, there is insufficient scientific evidence to propose a specific biopsy scheme that could fit every candidate, providing accurate characterization of the disease in the individual patient. Further research is necessary to establish solid selection protocols that would reliably identify appropriate candidates for FT of PCa.

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Re-biopsy of the Prostate Using a Stereotactic Transperineal Technique

Cited by 64 publications

References 19 publications

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

When prostate cancer remains undetectable: The dilemma

Prostate Biopsy in Selecting Candidates for Hemiablative Focal Therapy

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