Diagnostic efficacy and safety of transperineal prostate targeted and systematic biopsy: The preliminary experience of first 100 cases

Abstract

Background: Post-biopsy urosepsis is a major concern for patient morbidity and cost. Trasperineal biopsy is reported to have less complications and higher detection rate of clinically significant prostate cancer (csPCa).Objectives: To determine the diagnostic efficacy and safety of transperineal prostate biopsy in patients with elevated prostatic specific antigen (PSA). Material and methods: A prospective study included men with elevated PSA > 3 ng/ml and previous negative biopsy from January 2018 to April 2019. All patients had multiparametric magnetic resonance imaging (mpMRI) and suspicious lesions reported as Prostate Imaging Reporting and Data System (PIRADS) score version 2. Average twelve systematic and two targeted cores were biopsied under general anaesthesia. Patients received single dose of antibiotic prebiopsy. Results: 100 Consecutive patients having median age 64.0 years and median PSA of 6.1ng/ml were included for mpMRI-US fusion transperineal biopsies. Cancer detection rate was 45% (targeted 38% and systematic 22%) and csPCa were detected in 75.55% (targeted 86.84% and systematic 59.09%). MRI-US fusion targeted biopsies detected 63.88% csPCa in PIRADS 5, 33.33% in PIRADS 4 and 5.88% in PIRADS 3 lesions. PSA > 10 (p = 0.012), PSA density > 0.15 (p = 0.0002), and PIRADS 5 (0.0001) were significantly associated with PCa. Factors like Age (0.0001), initial PSA (0.022) and PSA density (0.006) were significant on univariate analysis while age (0.0001) was significant on multivariate analysis. There was no case of urinary tract infection. Conclusions: Transperineal prostate biopsy is safe and effective in diagnosing csPCa. There is no risk of sepsis and major complications.

A Systematic Review of the Current Status of Magnetic Resonance–Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies

“…Of the 30 articles, 21 studies were conducted prospectively (none randomized) [ 21 , 22 , 24 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 48 , 49 , 50 ] and nine retrospectively [ 23 , 25 , 26 , 31 , 36 , 37 , 44 , 45 , 47 ].…”

“…Eight series were multicenter [ 21 , 24 , 25 , 26 , 34 , 35 , 40 , 49 ] while the remaining 22 were from a single center [ 22 , 23 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 ]. Overall, the characteristics and biopsy results of 11,313 patients were analyzed.…”

“…The study population included two articles [ 42 , 45 ] on patients with naïve biopsy, three articles [ 34 , 35 , 48 ] on patients with previous negative biopsy, twelve articles [ 22 , 23 , 24 , 26 , 28 , 30 , 32 , 33 , 36 , 41 , 43 , 44 ] on patients with naïve biopsy and previous negative biopsy, eleven studies [ 27 , 29 , 31 , 37 , 38 , 39 , 40 , 46 , 47 , 49 , 50 ] on patients with naïve biopsy and previous negative biopsy and patients in active surveillance (AS) and finally, two articles by Jacewicz et al [ 21 , 25 ] on patients with no prior biopsy, patients with prior negative biopsy, AS, focal therapy (FT) control, and SBRT recurrence. These data are presented in Table 3 .…”

“…All resonances performed prior to the biopsies were carried out via 1.5 or 3.0 Tesla resonators scans and interpreted using the PI-RADS score Version 1.0 in 1 article [ 34 ], version 2.0 in 26 studies [ 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 50 ], and version 2.1 in 1 article [ 45 ]. In two series [ 26 , 49 ], the reading of the resonance was carried out using the Likert scale.…”

Morbidity following transperineal prostate biopsy: Our experience in 8.500 men

“…Prostate cancer (PCa) is the most frequent tumor diagnosed in men with about 2 million procedures carried out in the United States and Europe every year (1). Although it has an overlapping detection rate for PCa with respect to transrectal procedure, transperineal biopsy is recommended as the first-choice technique for diagnosis of prostate cancer owing to lower rates of post-procedural sepsis in comparison with transrectal approach (2)(3)(4). Although the use of targeted antibiotic therapy obtained by rectal swab culture and rectal preparation with povidone-iodine decrease the risk of infections and/or sepsis…”