Cancer detection and complications of transperineal prostate biopsy with antibiotics when indicated

Abstract

ObjectivesTo describe the prostate cancer (PCa) detection rate, including clinically significant prostate cancer (csPCa), in a large cohort of patients who underwent transperineal ultrasonography‐guided systematic prostate biopsy (TPB‐US) using a probe‐mounted transperineal access system, with magnetic resonance imaging (MRI) cognitive fusion in case of a Prostate Imaging–Reporting and Data System grade 3–5 lesion, under local anaesthesia in an outpatient setting. Additionally, to compare the incidence of procedure‐related complications with a cohort of patients undergoing transrectal ultrasonography‐guided (TRB‐US) and transrectal MRI‐guided biopsies (TRB‐MRI).Patients and MethodsThis was an observational cohort study in men who underwent TPB‐US prostate biopsy in a large teaching hospital. For each participant, prostate‐specific antigen level, clinical tumour stage, prostate volume, MRI parameters, number of (targeted) prostate biopsies, biopsy International Society of Uropathology (ISUP) grade and procedure‐related complications were assessed. csPCa was defined as ISUP grade ≥2. Antibiotic prophylaxis was only given in those with an increased risk of urinary tract infection.ResultsA total of 1288 TPB‐US procedures were evaluated. The overall detection rate for PCa in biopsy‐naive patients was 73%, and for csPCa it was 63%. The incidence of hospitalization was 1% in TPB‐US (13/1288), compared to 4% in TRB‐US (8/214) and 3% in TRB‐MRI (7/219; P = 0.002).ConclusionsContemporary combined systematic and target TPB‐US with MRI cognitive fusion is easy to perform in an outpatient setting, with a high detection rate of csPCa and a low incidence of procedure‐related complications.

Targeted multiparametric magnetic resonance imaging/transrectal ultrasound‐guided (mpMRI/TRUS) fusion prostate biopsy versus systematic random prostate biopsy: A comparative real‐life study

“…The transperineal method has garnered attention for its perceived advantages, heralded not only for its potential to mitigate infectious complications but also for its improved diagnostic precision. Moreover, its efficacy in the context of repeat biopsies presents a compelling argument for its consideration as the new standard of care (SOC) 25–27 …”

“…Moreover, its efficacy in the context of repeat biopsies presents a compelling argument for its consideration as the new standard of care (SOC). [25][26][27] Our study has several limitations: first, our data are acquired and analyzed in a retrospective, single-center study design that included patients who had biopsies in the urology department. Patients who had active surveillance or radiotherapy were excluded from the part analyzing RP data.…”

“…Moreover, its efficacy in the context of repeat biopsies presents a compelling argument for its consideration as the new standard of care (SOC). 25 , 26 , 27 …”

Correlation between Prostate Cancer Positive Cores and ⁶⁸Ga-PSMA Distribution in Prostate Gland

“…First, retrospective and low-numbered design of a single-center study might affect the evaluation of PSMA/PET as a triage tool. Although transperineal biopsy approach has many advantages regarding diagnosis, rebiopsy rates, and biopsy-related infection, transrectal approach was used in our study group [28,29]. Applying 68 Ga-PSMA PET prior to TRUS-bx could have given more details to assess the mentioned objectives; however, such a manner has not been recommended in the guidelines yet.…”

Evaluating the Effectiveness and Safety of Robotic-Assisted MRI/TRUS Fusion Transperineal Prostate Biopsy Systems: A Narrative Review Based on Current Literature

“…Due to its association with the rectal mucosa, transrectal biopsy carries a high risk of infection. 6 Therefore, the European Urology Association prostate cancer guidelines recommend that the biopsy of the prostate be performed primarily by the transperineal approach. 7 Although transperineal prostate biopsy is advantageous for infectious complications, it is associated with drawbacks such as a long learning curve and a longer procedural duration when compared to transrectal biopsies.…”