Complication rates of transrectal and transperineal prostate fusion biopsies – is there a learning curve even in high volume interventional center?

Purpose: To evaluate the eff ectiveness of mapping-targeted biopsies (MTB) on the index lesion for the detection of clinically significant prostate cancer (csPCa) in transperineal fusion-image prostate biopsies. Materials and Methods:A retrospective analysis was conducted on 309 men with suspected PCa who underwent prostate biopsies at the Creu Blanca reference center in Barcelona, Spain. The Prostate Imaging-Reporting and Data System (PI-RADS v.2.1) of the magnetic resonance images (MRI) were reclassified by an expert radiologist reading of pre-biopsy biparametric MRI used for segmentation of suspected lesions. Transperineal MTB of suspicious lesions and 12-core systematic biopsies were performed using the Artemis™ platform.CsPCa was defined as International Society of Urological Pathology grade group ≥ 2.Results: CsPCa was detected in 192 men (62.1%), with detection rates of 6.3% for PI-RADS 2, 26.8% for PI-RADS 3, 87.3% for PI-RADS 4, and 93.1% for PI-RADS 5. MTB of the index lesion identified 185 csPCa (96.3%). CsPCa was detected solely in systematic biopsies in three cases (1.6%), while an additional four cases (2.1%) were identified only in the second suspected lesion. A predictive model for csPCa detection in MTB of the index lesion was developed, with an AUC of 0.918 (95% CI 0.887-0.950). Conclusions:This model had the potential to avoid 23.3% of prostate biopsies without missing additional csPCa cases. MTB of the index lesion was highly eff ective for identifying csPCa in fusion transperineal prostate biopsies. A developed predictive model successfully reduced the need for almost one quarter of biopsies without missing csPCa cases.

Section: Discussionmentioning

confidence: 99%

The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies

Paesano,

Catalá,

Tcholakian

et al. 2024

“…Transrectal ultrasound (TRUS)-guided systematic extended sextant 12-core PBx were performed transrectally, using the Koelis ® system (Koelis ® , Grenoble, France) and 18G needle-biopsy, under local anesthesia by two experienced urologists at USC (OU and ALA), as previously described (6,10,(14)(15)(16). The same template was applied to all patients (6,10).…”

Section: Prostate Biopsy Protocolmentioning

confidence: 99%

A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI

Kaneko,

Fujihara,

Iwata

et al. 2024

Purpose: To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). Materials and Methods:We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination.Discrimination was evaluated with area under the receiver operating characteristic (AUROC).Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC.Results: Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. Conclusions:Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI

“…Dr. Moratti Gilberto and collegues from Brazil performed in page 334 ( 4 ) an interesting study about the complication rates of transrectal and transperineal prostate fusion biopsies in a high-volume interventional center and concluded that the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of transperineal prostate biopsy and the absence of infectious prostatitis imply a safer procedure when compared to transrectal prostate biopsy.…”

mentioning

confidence: 99%

MRI-TRUS fusion targeted biopsy is highligheted in International Brazilian Journal of Urology

Favorito

2023

The May-June number of Int Braz J Urol is the 22 nd under my supervision. In this number the Int Braz J Urol presents original contributions with a lot of interesting papers in different fields: Robotic Surgery, Prostate Cancer, Endometriosis, Translational Research, Male Health and Renal stones, Kidney Cancer, Bladder Cancer and UPJ obstruction. The papers came from many different countries such as Brazil, Italy, China, Saudi Arab and USA, and as usual the editor´s comment highlights some of them. The editor in chief would like to highlight the following works:Dr. Wang and collegues from China, presented in page 281 (1) a nice systematic review about the impact of body mass index (BMI) on size and composition of urinary stones and concluded that the current evidence suggests a positive association between BMI and uric acid and calcium oxalate stones. It would be of great guiding significance to con-sider losing weight when treating and preventing urinary stones.Dr. Ribeiro-Julio and collegues from Brazil, presented in page 299 (2) a important review about the anatomy of the lower hypogastric plexus applied to endometriosis and concluded that the Accurate knowledge of the innervation of the female pelvis is of fundamental importance for prevention of possible injuries and voiding dysfunctions as well as the evacuation mechanism in the postoperative period. Imaging exams such as nuclear magnetic resonance are interesting tools for more accurate visualization of the distribution of the hypogastric plexus in the female pelvis.Dr. da Silva and collegues from Brazil, performed in page 320 (3) a interesting translational research about the effects of dutasteride and tamsulosin on penile morphology in a rodent model and concluded that both treatments with dutasterid and tamsulosin promoted penile morphometric modifications in a rodent model. The combination therapy resulted in more notable modifications. The results of this study may help to explain the erectile dysfunction observed in some men using these drugs.Dr. Moratti Gilberto and collegues from Brazil performed in page 334 (4) an interesting study