Transperineal prostate biopsy navigated with US/MRI fusion

Czech version

Authors: Kateřina Ryšánková ^1,2; Pavla Hanzliková ^3,4; Adéla Vrtková ^5,6; Tereza Albínová ¹; Matěj Jendřejek ¹; Jan Krhut ^1,2
Authors‘ workplace: Urologická klinika Fakultní nemocnice Ostrava, Ostrava – Poruba ¹; Katedra chirurgických oborů LF Ostravské univerzity, Ostrava – Vítkovice ²; Ústav radiodiagnostický Fakultní nemocnice Ostrava, Ostrava – Poruba ³; Ústav zobrazovacích metod LF Ostravské univerzity, Ostrava – Vítkovice ⁴; Katedra aplikované matematiky, Fakulta elektrotechniky a informatiky, VŠB – Technická, univerzita Ostrava, Ostrava – Poruba ⁵; Útvar náměstka ředitele pro vědu a výzkum, Fakultní nemocnice Ostrava, Ostrava – Poruba ⁶
Published in: Ces Urol 2021; 25(1): 27-34
Category: Original Articles

Overview

Ryšánková K, Hanzlíková P, Vrtková A, Albínová T, Jendřejek M, Krhut J. Transperineal prostate biopsy navigated with US/MRI fusion.

Major statement: US/MRI fusion transperineal prostate biopsy has comparable yield and lower risk of infectious complications than transrectal biopsy.

Purpose: Nowadays, prostate biopsies performed transperineally are gaining prominence. In our cohort, we retrospectively evaluated the yield of transperineally performed biopsies and at the same time their safety, especially with regard to infectious complications.

Patients and methods: From January 2019 to March 2020, we performed 208 fusion US/MRI guided prostate biopsies – transperineally. Magnetic resonance imaging was evaluated by the PI-RADS vs 2 and vs 2.1 scoring systems, respectively. In biopsy naive patients we performed systematic biopsy from the peripheral zone and took at least three samples from the lesion described by the radiologist. In patients with repeated biopsy, we made a targeted biopsy with at least three samples from the lesion or lesions PI-RADS ≥ 3, but we did not make a systematic biopsy.

Results: The overall yield of the method in our group, regardless of the PI-RADS score, was 52.9 % of proven cancers in biopsy naive patients, of which 35.3 % were clinically insignificant and 17.6 % were clinically significant. In rebiopsy, 53.6 % of cancers were detected, of which 38.6 % were clinically insignificant and 15 % were clinically significant When comparing the yield according to the PIRADS score, in the PI-RADS 3 group a total of 68.5 % were negative, 31.5 % positive (27.8 % insignificant and 3.7 % significant), in the PI-RADS 4 group it was 44.3 % negative and 55.7 % positive (41.8 % and 13.9 %, respectively), in the PI-RADS 5 group 22.9 % negative, 77.1 % positive (43.8 % and 33.3 %, respectively). There was a statistically significant difference in the yield of biopsies (Chi-square test of independence for contingency tables, P < 0.001). We also assessed the complications of the procedure and we found that 182 patients underwent the procedure without any complications. As our main outcome measure, infectious complications, we recorded only two patients with dysuria, but without evidence of bacterial infection.

Conclusion: The yield of transperineally performed prostate biopsy in our cohort corresponds to literature data. We have noticed a minimum of complications, and therefore we believe that biopsy performed this way is a safe alternative.

Keywords:

diagnostic – fusion MRI/US prostate biopsy – transperineal prostate biopsy – urinary tract infection

Sources

1. Stefanova V, Buckley R, Flax S, et al. Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1, 287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability. J Urol 2019; 201(6): 1121–1126.

2. https://www.svod.cz/report.php?diag=C61. Přístup 7. 12. 2020.

3. Johansen TEB, Zahl PH, Baco E, et al. Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: first report from the Norwegian Patient Registry. World J Urol 2020; 38(1): 17–26. doi: 10.1007/ s00345-019-02837-0. Epub 2019 Jun 10.

4. Turkbey B, Rosenkrantz AB, Haider MA, et al. Prostate Imaging Reporting and Data System Version 2. 1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol 2019; 76(3): 340–351. doi: 10.1016/j.eururo.2019. 02. 033.

5. Weinreb JC, Barentsz JO, Choyke PL, et al. PI‑RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. Eur Urol 2016; 69(1): 16–40. doi: 10.1016/j.eururo.2015. 08. 052.

6. Stejskal J, Jašková V, Pavličko A, et al. Diagnostika karcinomu prostaty pomocí fúzní biopsie. Ces Urol 2018; 22(2): 87–98.

7. Wetterauer C, Shahin O, Federer‑Gsponer JR, et al. Feasibility of freehand MRI/US cognitive fusion transperineal biopsy of the prostate in local anaesthesia as in‑office procedure‑experience with 400 patients. Prostate Cancer Prostatic, DiS 2020; 23(3): 429–434. doi: 10.1038/s41391-019-0201-y. Epub 2020 Jan 2.

8. Marra G, Ploussard G, Futterer J, Valerio M; EAU‑YAU Prostate Cancer Working Party. Controversies in MR targeted biopsy: alone or combined, cognitive versus software‑based fusion, transrectal versus transperineal approach? World J Urol 2019; 37(2): 277–287. doi: 10.1007/s00345-018-02622-5. Epub 2019 Jan 4.

9. Mottet N, Bergh RCN, Briers E, et al. EAU guidelines on prostate cancer. EAU Guidelines. Edn. Presented at the EAU Annual Congress Copenhagen, 2018. ISBN 978-94-92671-01-1.

10. Konsensus používání antibiotik: Fluorochinolony 2019, Česká lékařská společnost Jana Evangelisty Purkyně. Subkomise pro antibiotickou politiku (SKAP). http://www.cls.cz/antibioticka‑politika‑a. Přístup 28. 9. 2020.

11. Baba K, Sekine Y, Miyazawa Y, et al. Assessment of antimicrobiral prophylaxis in transperineal prostate biopsy: a single‑center retrospective study of 485 cases. J Infect Chemother 2018; 24(8): 637–640. doi: 10.1016/j.jiac.2018. 03. 014.

12. Xiang J, Yan H, Li J, et al. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta‑analysis. World J Surg Oncol 2019; 17(1): 31. doi: 10.1186/s12957-019-1573-0.

13. Berry B, Parry MG, Sujenthiran A, et al. Comparison of complications after transrectal and transperineal prostate biopsy: a national population‑based study. BJU Int 2020; 126(1): 97–103. doi: 10.1111/bju.15039. Epub 2020 Apr 6.

14. Ahdoot M, Wilbur AR, Reese SE, et al. MRI‑Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis. N Engl J Med 2020; 382(10): 917–928. doi: 10.1056/NEJMoa1910038.

15. Shigemura K, Yamanaka N, Yamashita M. Can diffusion‑weighted magnetic resonance imaging predict a high Gleason score of prostate cancer? Korean J Urol 2013; 54(4): 234–238. doi: 10.4111/kju.2013. 54. 4.234.