Transperineal Prostate Biopsy: High Detection Rate and Low Complications with MRI Fusion

What is it about?

This study evaluated the prostate cancer (PCa) detection rate and incidence of procedure-related complications in 1288 patients who underwent transperineal ultrasonography-guided systematic prostate biopsy (TPB-US) with magnetic resonance imaging (MRI) cognitive fusion in an outpatient setting. The overall detection rate for PCa was 73%, and for clinically significant prostate cancer (csPCa) it was 63%. The incidence of hospitalization was 1% in TPB-US, compared to 4% in transrectal ultrasonography-guided biopsies and 3% in transrectal MRI-guided biopsies. This method is easy to perform, with a low incidence of procedure-related complications. The detection rate for csPCa was high and comparable to other studies using similar methods. This study was conducted on a large cohort of men who underwent TPB-US prostate biopsy in a teaching hospital. The prostate-specific antigen level, clinical tumour stage, prostate volume, MRI parameters, number of biopsies, biopsy International Society of Uropathology (ISUP) grade, and procedure-related complications were assessed. The csPCa was defined as ISUP grade ≥2. The study found that antibiotic prophylaxis was only given in those with an increased risk of urinary tract infection. Several studies have shown that this procedure is technically feasible and well tolerated by patients. However, the detection rate associated with this method is affected by several factors, such as intra-and interobserver variation in MRI of the prostate and Gleason score, and variation in the method used to perform prostate biopsies. The study reported that the detection rate for csPCa was 30%, 54% and 85% for PI-RADS 3-5 lesions, respectively, which is comparable to other studies using similar methods. The study found that omitting systematic biopsies and performing only targeted MRI-guided biopsy led to missed diagnoses of csPCa in 8.8% of cases. However, initiating targeted MRI-guided biopsy only is the most efficient diagnostic route in cases of PI-RADS 3-5 lesions. The study also found that in 8% of patients overall, csPCa would have been misdiagnosed when only MRI-targeted biopsies of PI-RADS 3-5 lesions were performed. Therefore, using a risk calculator including the results of the

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Why is it important?

The study is important because it assesses the prostate cancer detection rate and complications associated with transperineal ultrasonography-guided systematic prostate biopsy using a probe-mounted transperineal access system with magnetic resonance imaging cognitive fusion in a large cohort of patients. The results show that this method has a high detection rate of clinically significant prostate cancer (csPCa) and a low incidence of procedure-related complications, making it a viable alternative to transrectal ultrasonography-guided and transrectal MRI-guided biopsies. Key Takeaways: 1. The overall detection rate for PCa in biopsy-naive patients was 73%, and for csPCa it was 63%. 2. The incidence of hospitalization was 1% in TPB-US, compared to 4% in TRB-US and 3% in TRB-MRI. 3. The detection rate associated with systematic biopsies combined with target cognitive fusion biopsies was high, with a rate of csPCa detection (ISUP grade ≥2) for PI-RADS 3-5 lesions of 30%, 54%, and 85%, respectively. 4. The study highlights the importance of using a risk calculator including the results of the MRI to achieve appropriate patient selection for prostate biopsy. 5. The use of antibiotic prophylaxis in patients with an increased risk of urinary tract infection is recommended, but its use does not significantly impact the incidence of complications.