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

Borghesi, Marco; Ahmed, Hashim U.; Nam, Robert K.; Schaeffer, Edward M.; Schiavina, Riccardo; Taneja, Samir S.; Weidner, W.; Loeb, Stacy

doi:10.1016/j.eururo.2016.08.004

Cited by 403 publications

(395 citation statements)

References 83 publications

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“…TRB carries a small but clinically significant and increasing risk of sepsis. TPB, whether MRI-targeted or not, consistently results in zero or near-zero rates of serious infection (1). Furthermore, it has now been shown that fluoroquinolones or other combinations of broad-spectrum antibiotics are not necessary for prophylaxis in TPB.…”

Section: Discussionmentioning

confidence: 99%

“…Each needle passage risks inoculating the prostate and its rich blood supply with rectal bacteria. As a “dirty” procedure, prophylactic antibiotics are necessary and fluoroquinolones are currently recommended as the antibiotics of choice (1,13). However, there are three major concerns regarding the widespread use of fluoroquinolones in TRB.…”

Section: Mri-targeted Transrectal Biopsy (Trb)mentioning

confidence: 99%

“…Second, despite being the recommended prophylactic antibiotic, fluoroquinolones are losing their efficacy due to rising rates of resistance in rectal flora (15-17) and there is evidence that sepsis rates are consequently rising (1). Nam et al reported a population-based study of over 75,000 men in Canada undergoing TRB in the 10 years to 2005.…”

Section: Mri-targeted Transrectal Biopsy (Trb)mentioning

confidence: 99%

“…However, there is scant evidence that this reduces infection risk. In Borghesi et al ’s recent systematic review (1), only one study of 54 cases is cited showing a possible benefit, but it was not statistically significant (34). …”

Section: Mri-targeted Transrectal Biopsy (Trb)mentioning

confidence: 99%

“…Although imaging with multiparametric magnetic resonance imaging (mpMRI) has the potential to increase detection and localisation of prostate cancer, tissue is still required for histological confirmation. It is estimated that more than 2 million prostate biopsies are performed around the world every year (1). …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Transperineal vs. transrectal biopsy in MRI targeting

Grummet¹,

Pepdjonovic²,

Huang

et al. 2017

Transl. Androl. Urol.

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Prostate biopsy is typically performed via either the transrectal or transperineal approach. MRI-targeted biopsy, whether using any of the three options of cognitive fusion, MRI-ultrasound fusion software, or in-bore MRI-guided biopsy, can also be performed via either transrectal or transperineal approaches. As an extension of traditional random prostate biopsy, the transrectal approach is far more commonly used for MRI-targeted biopsy due to its convenience. However, in the context of today’s increasing multi-drug resistance of rectal flora, the transperineal approach is being used more often due to its lack of septic complications. In addition, only a first-generation cephalosporin, not a fluoroquinolone, is required as antibiotic prophylaxis. Evidence shows excellent detection rates of significant prostate cancer using magnetic resonance imaging (MRI)-targeted and/or systematic transperineal biopsy (TPB). However, there are no head-to-head studies comparing the different MRI-targeted methods within TPB. To provide truly patient-centred care, the biopsy technique using the safest method with the highest detection rate of significant cancer should be used. Depending on healthcare context and hospital resource utilization, MRI-targeted TPB is an excellent option and should be performed wherever available and feasible. Whilst building capacity for TPB in one’s practice, the routine use of rectal culture swabs prior to any transrectal biopsies is strongly encouraged. Independent of biopsy route, the addition of systematic cores needs to be discussed with the patient weighing maximal detection of significant cancer against increased detection of insignificant lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Mri-targeted Transrectal Biopsy (Trb)mentioning

confidence: 99%

Section: Mri-targeted Transrectal Biopsy (Trb)mentioning

confidence: 99%

Section: Mri-targeted Transrectal Biopsy (Trb)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Transperineal vs. transrectal biopsy in MRI targeting

Grummet¹,

Pepdjonovic²,

Huang

et al. 2017

Transl. Androl. Urol.

View full text Add to dashboard Cite

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Prostate-Specific Antigen (PSA) Screening for Prostate Cancer

Carter

2018

JAMA

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A Pragmatic Approach to Prostate Cancer Screening

Tosoian,

Penson,

Chinnaiyan

2024

JAMA

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The introduction of prostate-specific antigen (PSA)-based screening for prostate cancer in the early 1990s was followed by a nearly 2-decade long decline in prostate cancer metastasis and mortality. 1 However, clinical trial data revealed that screening was associated with substantial harms. 2 Under the traditional clinical approach in which elevated serum PSA triggered prostate biopsy, roughly 1 in 5 screened men underwent biopsies, with more than 75% found to be negative and a majority of positive biopsies harboring low-grade, clinically insignificant cancers. 3 Prostate biopsies are uncomfortable for patients and carry a risk of bleeding and infection requiring hospitalization. 4 Moreover, during a previous era in which a cancer diagnosis was inexorably linked to treatment, overdiagnosis (ie, detection of indolent cancers that would not have been detected during life in the absence of screening) and overtreatment resulted in significantly reduced quality of life. 5 In 2012, the US Preventive Services Task Force (USPSTF) provided a grade D recommendation against the use of PSA screening, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms. 6 In the time since, longer-term outcomes from highquality studies have better informed the benefits of screening. After 22 years of follow-up in the Gotebörg screening trial, 7 the rate ratio for prostate cancer death in screening participants was 0.59 (95% CI, 0.43-0.80), with a number needed to invite to screening of 221 and number needed to treat of 9 to prevent 1 death from prostate cancer-figures that compare favorably with other common cancers. 8,9 At the same time, a growing understanding of prostate cancer has led to advances to reduce the harms previously associated with screening. For men with favorable-risk cancers, adoption of active surveillance-a management strategy centered on monitoring rather than immediate treatment-has reduced overtreatment and its associated adverse effects. 10 In large part due to these studies quantifying benefit and development of approaches to minimize harms, in 2018 the USPSTF offered an updated grade C recommendation for PSA screening, recommending individualized decision-making in men aged 55-69 years. 11 Current clinical guidelines emphasize a narrowed diagnostic focus on identifying higher-grade cancers, recommending that patients with an elevated PSA level undergo magnetic resonance imaging (MRI), if available, or biomarker testing to better define the risk of high-grade (grade group [GG] ≥2) disease prior to biopsy. 12-14 Indeed, MRI with targeted biopsy improves detection of high-grade cancers relative to stan-Multimedia

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

Cited by 403 publications

References 83 publications

Transperineal vs. transrectal biopsy in MRI targeting

Transperineal vs. transrectal biopsy in MRI targeting

Prostate-Specific Antigen (PSA) Screening for Prostate Cancer

A Pragmatic Approach to Prostate Cancer Screening

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