Role of Perilesional Sampling of Patients Undergoing Fusion Prostate Biopsies

Abstract

Recently, researchers have proposed perilesional sampling during prostate biopsies to avoid systematic biopsies of patients at risk of prostate cancer. The aim of our study is to evaluate the role of perilesional sampling to avoid systematic biopsies of patients undergoing fusion biopsies. A prospective cohort of patients undergoing transrectal MRI transrectal fusion biopsies were consecutively enrolled. All the patients underwent systematic biopsies (SB), targeted biopsies (TB) and perilesional biopsies within 10 mm from the lesion (PB). The detection rates of different strategies were determined. A total of 262 patients were enrolled. The median age of those enrolled was 70 years. The mean BMI was 27 kg/m2, and the mean and prostate volume was 52 mL. A PIRADS score ≥ 4 was recorded in 163/262 (40%) patients. Overall, the detection rates of cancer were 43.5% (114/262) and 35% (92/262) for csPCa. The use of the target + peri-target strategy resulted in a detection of 32.8% (86/262) of cancer cases and of 29% (76/262) of csPCa cases (Grade Group > 2). Using the target plus peri-target approach resulted in us missing 18/262 (7%) of the csPCa cases, avoiding the diagnosis of 8/262 (3%) of nsPCa cases. A biopsy strategy including lesional and perilesional sampling could avoid unnecessary prostate biopsies. However, the risk of missing significant cancers is present. Future studies should assess the cost–benefit relationship of different strategies.

Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

“…FUS-TBs were performed on the patient placed in a left lateral decubitus position. Prior to the procedural date, due to hospital protocols and according to local antimicrobial resistance, patients were administered prophylactic antibiotic therapy with oral sulfamethoxazole and trimethoprim (800 mg + 160 mg; 2 tabs per day) for three days before the biopsy and two days after and amikacin 500 mg iv periprocedurally [25][26][27][28][29]. Povidone-iodine rectal preparation was administered prior to the procedure.…”

A novel biopsy scheme for prostate cancer: targeted and regional systematic biopsy

“…Recently, research has explored MRI-TB combined with only regional SB as an optimized approach to reduce biopsy cores [12][13][14][15][16]. Additionally, terms like focal saturation biopsy, perilesional biopsy, regional TB, and targeted sector biopsy have appeared in the literature [14,15,[17][18][19][20]. All these studies aimed to reduce the number of unnecessary SB cores while maintaining detection rates for clinically significant PCa (csPCa).…”