Mp24-16 local Anaesthetic Transperineal Prostate (Latp) Biopsy Using the Precision Point Access System: A Multi-Centre Outcome Analysis

Abstract

to detect prostate cancer (PCa) due to targeting error, inadequate sampling, or did the radiologist overcall the MRI lesion as positive? This perplexing situation leads to clinical uncertainty as to whether repeating another MR/US fusion biopsy session would be beneficial. In this study, we sought to determine whether ConfirmMDxÒ, a validated DNA methylation field effect assay, would be clinically useful if applied to TB þ SB cores with benign pathology.METHODS: In a retrospectively maintained database, we identified 142 consecutive patients who underwent MR/US fusion TB þ SB for PIRADS !3 following at least one negative SB session. Multiparametric MRI was performed using a 3-Tesla scanner and scored using PI-RADS Version 2. Among the 142 patients who underwent biopsy, 65 patients had benign pathology and were offered subsequent ConfirmMDxÒ testing of the benign TB þ SB cores. ConfirmMDxÒ was performed in a total 44 patients and alterations in GSTP1, APC, and RASSF1 correlated with abnormal regions of interest (ROI) on MRI based on corresponding sextant location.RESULTS: Among 44 patients who underwent ConfirmMDxÒ, 18/44 (40.9%) exhibited DNA hypermethylation of either GSTP1, APC, or RASSF1, while 6/44 (13.6%) exhibited hypermethylation of least two genes. DNA hypermethylation of GSTP1, APC, or RASSF1 within and outside the ROI was observed in 7/44 (15.9%) and 14/44 (31.8%) of patients, respectively. There was no correlation between PIRADS score and hypermethylation status (p > 0.05).CONCLUSIONS: Given that DNA hypermethylation of GSTP1, APC, and RASSF1 was uncommon in the benign tissue sampled from MRI-positive regions, repeating a TB will likely have low yield for detecting clinically significant PCa. In the future, sextant sampling of regions with field effects may be a more effective means of detecting occult PCa in this specific population of patients.

Gelokaliseerde prostaatkanker – EAU highlights

“…De vervolgstappen in dit scenario zijn afhankelijk van het vermoeden dat het initiële prostaatbiopt accuraat genoeg was, zeker wanneer dit biopt transrectaal werd genomen. Dit komt voort uit data van Campbell et al, die in hun series 257 mannen includeerden met PI-RADS 4 of 5, bij wie de eerste transrectale biopten negatief waren [11]. De kans op de aanwezigheid van klinisch-significant prostaatcarcinoom bleek bij deze mannen 34% bij herhaalde transperineale biopten.…”

Incidence of Infection Following Local Anesthetic Transperineal Prostate Biopsy: A Single-Centre Experience

“…Local anesthetic transperineal prostate biopsy (LATP) is a widely accepted and well-tolerated procedure for diagnosing prostate cancer. It offers several advantages over traditional TR biopsy, including reduced infection and sepsis risk, improved sampling of the apical and anterior prostate regions, and potentially higher cancer detection rates [4][5][6]. Among men under active surveillance for low-risk prostate cancer, LATP is more adept at identifying clinically significant cases, likely due to improved sampling of the anterior prostate region [7].…”