Initial series of magnetic resonance imaging (<scp>MRI</scp>)‐fusion targeted prostate biopsy using the first transperineal targeted platform available in the <scp>USA</scp>

Kosarek, Christopher D.; Mahmoud, Alì Mokhtar; Eyzaguirre, Eduardo; Shan, Yong; Walser, Eric; Horn, Gary Lloyd; Williams, Stephen B.

doi:10.1111/bju.14206

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…TBx locations were sampled 4–6 times per lesion. Description of this technology for the transrectal approach as well as the transperineal approach has been previously published . Briefly, an EM field generator (Northern Digital Inc., Waterloo, ON, Canada) is positioned inferior to the pubic symphysis – either anterior or lateral to the custom stepper with embedded EM‐tracking sensors (Philips Healthcare), allowing real‐time stereotactic tracking of a transrectal biopsy probe (8848; BK Medical North America, Peabody, MA, USA) and an 18‐gauge AccuCARE disposable template grid (Civco Medical Solutions, Coralville, IA, USA).…”

Section: Methodsmentioning

confidence: 99%

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

et al. 2019

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Objective To evaluate the ability to detect clinically significant prostate cancer (PCa) using a novel electromagnetically (EM) tracked transperineal magnetic resonance imaging (MRI)/ultrasonography (US) fusion‐guided targeted biopsy (transperineal TBx) platform and the impact of inter‐reader variability on cancer detection. Materials and Methods A total of 176 patients with suspicious lesions detected on multiparametric MRI (mpMRI) underwent a systematic modified Barzel template biopsy (12‐core) transperineal biopsy (transperineal SBx) and transperineal TBx with EM tracking (UroNav; Philips Healthcare, Best, the Netherlands) in the same setting. Cancer detection rates (CDRs) were stratified by Prostate Imaging Reporting and Data System (PI‐RADS) v2 scores and compared with Fisher’s exact test. Area under the curve (AUC) was calculated for prostate‐specific antigen (PSA), PSA density (PSAD), PI‐RADS score, and subgroup analysis of individual readers' PI‐RADS scores with respect to overall CDR and clinically significant CDR. Results The overall CDR was 76.7% (135/176), of which 76.3% (103/135) was clinically significant PCa. Among the 135 patients with PCa, transperineal TBx detected 90.4% of cases (122/135), either alone or in combination with transperineal SBx. The remaining 9.6% of cases (13/135) missed by transperineal TBx were diagnosed by transperineal SBx alone, of which three were clinically significant. Conversely, transperineal SBx missed 14% of cases (19/135), 14 of which were clinically significant PCa. Sensitivities for transperineal TBx and transperineal SBx were 90.4% and 85.9%, respectively. On a per‐lesion basis, PI‐RADS score (AUC 0.74) outperformed both PSA (AUC 0.59) and PSAD (AUC 0.63) in discriminating clinically significant from non‐clinically significant PCa on transperineal TBx. Although not formally statistically tested, AUCs amongst different mpMRI readers appeared to display considerable variability. There were no adverse events, including sepsis. Conclusions Electromagnetically tracked transperineal TBx of MRI‐visible lesions enhanced the ability of transperineal SBx to detect PCa, with greater sensitivity for clinically significant disease. These findings suggest transperineal TBx is a safe, alternative fusion platform for patients with a suspicious lesion on prostate MRI. The assessment of inter‐reader variability, in conjunction with prediction of clinically significant PCa and CDR, is an important first step for quality control in implementing an MRI‐based screening programme.

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Section: Methodsmentioning

confidence: 99%

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

et al. 2019

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“…Overall prostate cancer detection was found at 81.3% with clinically significant cancer detection at 59.4%. 48 The transperineal approach is becoming more popular, even with the need for general anesthesia, because there is no need for antibiotic prophylaxis and no pain. 49 Furthermore, Calio et al .…”

Section: Commonly Used Mri Fusion Platformsmentioning

confidence: 99%

A review of optimal prostate biopsy: indications and techniques

Streicher

Meyerson

Karivedu

et al. 2019

Therapeutic Advances in Urology

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Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI–TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI–TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.

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“…Tрансперинеална МРТ/УЗ насочена простатна биопсия, в сравнение с трансректалната ултразвук насочена биопсия, e асоциирана с по-силна болкова симптоматика [13] и за купиране на болката изисква спинална или обща анестезия. [14,15,16] Златен стандарт при извършването на трансректална ултразвук-насочена простатна биопсия е локална анестезия с интраректална топикална анестезия и перипростатна нервна блокада. [17,18] Приложението й при МРТ/ УЗ-ТПБ е съпроводена от наличие на болка с VAS -3,1 +-2,3.…”

Section: обсъжданеunclassified

Saddle block anesthesia with 20 mg prilocaine hydrochloride 2% hyperbaric solution and intravenous fentanyl administration for transperineal MRI/US fusion-guided prostate biopsy

Dimov¹,

Gatsev²,

Gancheva³

et al. 2022

JEMIS

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Introduction: MRI-Ultrasound (MRI/US) fusion-guided transperineal prostate biopsy (TPB) is gaining popularity in the diagnostic algorithm of prostate cancer. It is associated with higher pain score than the other methods of prostate biopsy. Effective analgesia is a key point for providing patient comfort and preventing his movement in response to pain with subsequent mismatch of the fused MRI/ US images. The mismatch could lead to inaccurate targeting of suspected cancer lesions. The preferred method of analgesia in an outpatient setting is topical intrarectal administration of lidocaine and periprostatic nerve block, but the pain and the discomfort from the procedure are not completely eliminated. Hypothetically, saddle block anesthesia has an expected better efficacy in relieving the pain from the MRI/US-TPB. Aim: To evaluate the efficacy and safety of saddle block anesthesia in patients undergoing MRI/US-TPB and сomparative analysis between patients who have received and have not received intravenous fentanyl Material and methods: A prospective randomized study was conducted on 12 consecutive patients undergoing MRI/US-TPB. Saddle block anesthesia was performed with 20 mg prilocaine hydrochloride 2% hyperbaric solution to all patients. 6 patients received intravenous fentanyl at a dose of 1mcg/kg (Group 1) and 6 patients did not receive intravenous fentanyl. It was examined: patient’s age, weight, height, BMI and ASA class; duration from the dural puncture to the end of the surgical intervention; taken number of prostate biopsies; presence of intraoperative pain; motor blockage; presence of a difference of more than 20%, before and after saddle block anesthesia, of non-invasively measured blood pressure and heart rate; additional medication; presence of early postoperative complications and recovery time from anesthesia Results: The comparative analysis of the preoperative characteristics of the both groups did not reveal significant statistical difference. There were comparatively similar indicators for surgical intervention and regional anesthesia in both groups. The both anesthesia techniques showed safety profile with hemodynamic stability, without additional medicine administration and lack of early post-anesthesia complications. Pain did not occur during inserting and moving the US probe into the anal canal and puncturing the perineal skin and the underlying tissues. 50% (3) of the patients in Group 2 had pain during the puncture of the prostate gland and biopsy extraction, while in Group 1 - 0% (0) of the patients reported presence of pain. There was a slightly delayed onset of the first postoperative pain in Group 1 - 113.17 ± 15.11 min. compared to Group 2 - 99.83 ± 11.51 min. Conclusion: The saddle block anesthesia with 20 mg prilocaine hydrochloride 2% hyperbaric solution in combination with intravenous fentanyl at a dose of 1 mcg/kg is a safe anesthesia technique, associated with excellent analgesic profile, low incidence of anesthesia-related complications and rapid recovery in patients undergoing MRI/US-TPB. Key words: saddle block, transperineal MRI/US fusion-guided prostate biopsy, prilocaine hydrochloride 2% hyperbaric solution

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Initial series of magnetic resonance imaging (MRI)‐fusion targeted prostate biopsy using the first transperineal targeted platform available in the USA

Abstract: These results demonstrate the promising potential of the first transperineal targeted prostate biopsy platform in the USA as an alternative diagnostic method for PCa.

Cited by 9 publications

References 7 publications

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

A review of optimal prostate biopsy: indications and techniques

Saddle block anesthesia with 20 mg prilocaine hydrochloride 2% hyperbaric solution and intravenous fentanyl administration for transperineal MRI/US fusion-guided prostate biopsy

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