Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate: an original technique with a good cancer detection rate

Abstract

BackgroundTo report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB) .MethodsWe present a retrospective review of consecutive patients undergoing multiparametric magnetic resonance (mpMRI) imaging of the prostate with subsequent transperineal prostate biopsy from January 2016 to December 2018. A free-hand 12-core SB was performed for each patient. PI-RADS 3–5 lesions were further targeted for biopsy with our TB technique. Firstly, a central point of suspicious lesion (B′) was registered cognitively on a transverse section of transrectal ultrasound (TRUS). Then, biopsy gun punctured vertically through a fixed pioneer site (A) on skin of perineum, and deep into the TRUS section to get A’. Next, targeted site (B), the surface-projection of B′, would be determined on skin of perineum by A and distance from B′ to A’. Finally, puncture through B to reach B′. Pathological findings of SB and TB were analyzed.ResultsA total of 126 patients underwent transperineal prostate biopsy (47 SB only, 79 SB + TB). The age of the patients was 68.7 ± 9.2 years. The median preoperative PSA value was 11.8 ng/mL. Preoperative prostate volume was 60.5 ± 50.0 mL. The numbers of patients with PI-RADS scores of 1 through 5 were 4, 43, 27, 21 and 31, respectively. The overall detection rate of cancer was 61/126 (48.4%), and it was significantly higher in the combination cohort (56/79, 70.9%) compared with the SB only cohort (5/47, 10.6%, p<0.001). When focused on the combination cohort, TB detected a similar overall rate of PCa (53/79, 67.1% vs 52/79, 65.8%; p = 0.87) compared with SB. The clinically significant PCa (csPC) detection rate was 52/79 (65.8%), while for TB and SB the csPC/PC rate was 51/53 (96.2%) and 48/52 (92.3%), respectively(p = 0.44). TB demonstrated a better sampling performance (positive rate for each core) compared with SB (51.0% vs 31.3%, p < 0.001).ConclusionsSurface-projection-based transperineal cognitive fusion targeted biopsy of the prostate has a good efficacy in detecting PCa.

Investigation of the Effectiveness of Prostate Biopsy Density in Predicting Prostate Cancer Under Cognitive and Systematic Biopsy in Multi-Parametric Magnetic Resonance Imaging (mpMRI)

“…However, with the widespread use of mpMRI, the current recommendation is to combine systematic and targeted biopsies. 22 In this approach, the precise determination of the number of our puncture needles has emerged as a novel challenge, with clinical practice aspiring to achieve the least number of missed diagnoses using the minimal number of needles. Consequently, we have conducted an investigation into the contribution of biopsy density to the cancer detection rate.…”

Evaluating Transperineal Prostate Biopsies Performed by a New Operator: A Prospective Clinical Audit at Dorset County Hospital

“…Prostate biopsy plays a crucial role in the diagnosis and management of prostate cancer. Biopsy techniques have significantly evolved over the past several decades [2][3][4]. The transrectal (TR) approach, utilizing a transrectal ultrasound (TRUS) probe, remains the most widely used biopsy technique globally [5] due to its simplicity, low cost, and feasibility under local anesthesia.…”

Re: Sivaraman A, Ramasamy V, Aarthy P, Sankar V, Sivaraman PB. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience. Indian J Urol 2022;38:34-41

“…Using smart glasses and various simple coordinate-based methods, it has been shown that this method can have better results. [ 4 5 6 ] In addition, it was reported that cognitive fusion biopsy, which was previously performed entirely through the transrectal route, can also be performed by the transperineal route, which has a significant advantage in terms of local anesthesia requirement and infective complications, especially urosepsis. [ 7 ] However, a freehand transperineal cognitive fusion biopsy technique was defined with a simple instrument (PrecisionPoint device) without the need for a template unit.…”