Transperineal In-Bore 3-T MR Imaging–guided Prostate Biopsy: A Prospective Clinical Observational Study

Abstract

The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.q RSNA, 2014 Purpose:To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer (PCa) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population. Materials and Methods:This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years 6 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa diagnosis, men with PCa who were undergoing active surveillance, and men with treated PCa and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using x 2 and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons. Results:Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa, 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P , .001). Conclusion:In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly.q RSNA, 2014

Complications After Systematic, Random, and Image-guided Prostate Biopsy

“…However, in a biopsy-based multivariable analysis, the repeat biopsy procedure itself was not associated with a greater risk of serious complications requiring hospital admission compared to the initial biopsy session 59 . In patients undergoing transperineal PB, the reported incidence of infections and sepsis is close to zero (0-0.2%), given the avoidance of bacterial contamination (which is common during transrectal access), as well as the limited number of cores taken when performing transperineal MRI-guided in bore biopsy [8][9][10]13,[25][26][27]29,[63][64][65][66][67] . Although data are currently limited, it is uncertain whether the lower incidence of infectious complications after MRI-targeted PB could be related to the sampling route (i.e.…”

“…In a comparative series of patients undergoing transrectal MRI-targeted PB and TRUS-guided PB, the Authors found a lower incidence of infective complications in the former group (the rate of infections was halved compared to the latter), even if not statistically significant 14 . Conversely, the infectious complication rate after in-bore transperineal MRI-targeted biopsy appears virtually absent, with a hospitalization rate of 0% 29,64 .A minority of patients require hospitalization for the management of serious biopsy-related adverse events or the exacerbation of underlying medical conditions. Data on hospital admissions following PB were recently reported by Anastadiasis et al from the English national cancer registry 58 .…”

“…A recent statewide study from the Michigan Urological Surgery Improvement Collaborative (MUSIC) group, reported a reduction in hospitalization rates for infectious complications from 1.19% to 0.56%, when adopting a specific protocol for antibiotic prophylaxis (by shifting from a monotherapy to a multi-drug prophylaxis or performing culture-directed prophylaxis) 51 . Although transperineal approach for PB is infrequently used in many parts of the world largely due to logistical reasons, the incidence of re-admissions for urinary infection or sepsis is lower, ranging from 0% to 0.7% in published reports 9,10,25,26 (Table 2).Despite the currently limited available body of literature, the lower incidence of infections and hospitalizations among patients undergoing MRI-targeted PB appears mostly related to the transperineal access, rather than the number of cores taken 29,64 . In summary, the occurrence of serious major complications after transrectal PB requiring hospital admission, ranges from 0.5% to 6.9%, and has increased over time.…”

The prognostic value of repeated prostate fusion biopsy

“…• Fusion-биопсия имеет высокую эффективность при обнаружении опухолей передней зоны ПЖ, которые при классическом подходе не диагности-руются в 77 % случаев [14].…”

Spotlight on multiparametric magnetic resonance imaging in prostate cancer management: current perspectives

“…Software such as 3Dslicer (www .slicer.org) efficiently registers/fuses previously acquired mpMRI data on intraprocedural images and improves the accuracy of the biopsy targeting. 47 Focal ablative therapies use image guidance to ablate focal areas of prostate cancer within the gland with either heat (laser, high-frequency ultrasound) or cold temperature (cryo), and can be used to treat localized prostate cancer. mpMRI is the most reliable modality for image-guided focal therapies because of its high spatial resolution and accurate tumor detection.…”