Advertisement

Transperineal Free-hand mpMRI Fusion-targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single-center Prospective Study

Published:February 13, 2020DOI:https://doi.org/10.1016/j.urology.2019.11.078

      OBJECTIVE

      To evaluate the feasibility of “in-office” TPFBx under local anesthesia (LA).

      MATERIALS AND METHODS

      We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of prostate cancer (CaP), according to predefined exclusion criteria.

      RESULTS

      We included 459 men (TPFBx n = 279 including n = 338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n = 180). Median procedural time and maximum pain were 19 minutes and 5 numeric rating scale (NRS) points; pain was highest at the time of LA. Only 1 major complication occurred (Clavien 3a). Hematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and 1 case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (P = .86 and P = .89). In comparison with TPSBx the sole differences were pain during prostatic sampling (P = .03), duration of hematospermia (P <.0001) and procedural time (P <.001) all higher for TPFBx. Clinically significant (cs) CaP was detected in n = 150 (53.8%) patients in the TPFBx group (34.9%, 51.7%, and 75% of Pirads 3, 4, and 5, respectively). Addition of systematic cores detected n = 25 csCaP that were missed by targeted cores (17.4% of all csCaP).

      CONCLUSION

      TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csCaP detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kasivisvanathan V
        • Rannikko AS
        • Borghi M
        • et al.
        MRI-targeted or standard biopsy for prostate-cancer diagnosis.
        N Engl J Med. 2018; 378: 1767-1777
        • Marra G
        • Gontero P
        • Valerio M
        Changing the prostate cancer management pathway: why Focal Therapy is a step forward.
        Arch Esp Urol. 2016; 69: 271-280
        • Marra G
        • Ploussard G
        • Futterer J
        • Valerio M
        • Party E-YPCW
        Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach?.
        World J Urol. 2019; 37: 277-287
        • Rouvière O
        • Puech P
        • Renard-Penna R
        • et al.
        Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study.
        Lancet Oncol. 2019; 20: 100-109
        • van der Leest M
        • Cornel E
        • Israel B
        • et al.
        Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: a large prospective multicenter clinical study.
        Eur Urol. 2019; 75: 570-578
        • Emiliozzi P
        • Corsetti A
        • Tassi B
        • Federico G
        • Martini M
        • Pansadoro V
        Best approach for prostate cancer detection: a prospective study on transperineal versus transrectal six-core prostate biopsy.
        Urology. 2003; 61: 961-966
        • Kum F
        • Elhage O
        • Maliyil J
        • et al.
        Initial outcomes of local anaesthetic freehand transperineal biopsies in the outpatient setting.
        BJU Int. 2020; 125: 244-252
        • Meyer AR
        • Joice GA
        • Schwen ZR
        • Partin AW
        • Allaf ME
        • Gorin MA
        Initial experience performing in-office ultrasound-guided transperineal prostate biopsy under local anesthesia using the PrecisionPoint Transperineal Access System.
        Urology. 2018; 115: 8-13
        • Loeb S
        • van den Heuvel S
        • Zhu X
        • Bangma CH
        • Schroder FH
        • Roobol MJ
        Infectious complications and hospital admissions after prostate biopsy in a European randomized trial.
        Eur Urol. 2012; 61: 1110-1114
        • Chung HS
        • Hwang EC
        • Yu HS
        • et al.
        Prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy: a prospective multicenter study.
        Int J Urol. 2018; 25: 278-283
        • Giannarini G
        • Crestani A
        • Rossanese M
        • Ficarra V
        Multiparametric magnetic resonance imaging targeted biopsy for early detection of prostate cancer: All That Glitters Is Not Gold!.
        Eur Urol. 2017; 71: 904-906
        • Dindo D
        • Demartines N
        • Clavien PA
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Mitropoulos D
        • Artibani W
        • Graefen M
        • et al.
        Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations.
        Eur Urol. 2012; 61: 341-349
        • Moore CM
        • Kasivisvanathan V
        • Eggener S
        • et al.
        Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group.
        Eur Urol. 2013; 64: 544-552
        • Gatti M
        • Faletti R
        • Calleris G
        • et al.
        Prostate cancer detection with biparametric magnetic resonance imaging (bpMRI) by readers with different experience: performance and comparison with multiparametric (mpMRI).
        Abdom Radiol. 2019; 44: 1883-1893
        • Barentsz JO
        • Weinreb JC
        • Verma S
        • et al.
        Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use.
        Eur Urol. 2016; 69: 41-49
        • Bass EJ
        • Donaldson IA
        • Freeman A
        • et al.
        Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach.
        Prostate Cancer Prostatic Dis. 2017; 20: 311-317
        • Loeb S
        • Vellekoop A
        • Ahmed HU
        • et al.
        Systematic review of complications of prostate biopsy.
        Eur Urol. 2013; 64: 876-892
        • Borghesi M
        • Ahmed H
        • Nam R
        • et al.
        Complications after systematic, random, and image-guided prostate biopsy.
        Eur Urol. 2017; 71: 353-365
        • Shen PF
        • Zhu YC
        • Wei WR
        • et al.
        The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis.
        Asian J Androl. 2012; 14: 310-315
        • Novella G
        • Ficarra V
        • Galfano A
        • et al.
        Pain assessment after original transperineal prostate biopsy using a coaxial needle.
        Urology. 2003; 62: 689-692
        • Grummet JP
        • Weerakoon M
        • Huang S
        • et al.
        Sepsis and 'superbugs': should we favour the transperineal over the transrectal approach for prostate biopsy?.
        BJU Int. 2014; 114: 384-388
        • Carignan A
        • Roussy JF
        • Lapointe V
        • Valiquette L
        • Sabbagh R
        • Pepin J
        Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?.
        Eur Urol. 2012; 62: 453-459
        • Seitz M
        • Stief C
        • Waidelich R
        • Bader M
        • Tilki D
        Transrectal ultrasound guided prostate biopsy in the era of increasing fluoroquinolone resistance: prophylaxis with single-dose ertapenem.
        World J Urol. 2017; 35: 1681-1688
        • Bloomfield MG
        • Page MJ
        • McLachlan AG
        • Studd RC
        • Blackmore TK
        Routine ertapenem prophylaxis for transrectal ultrasound guided prostate biopsy does not select for carbapenem resistant organisms: a prospective cohort study.
        J Urol. 2017; 198: 362-368
        • Alanis AJ
        Resistance to antibiotics: are we in the post-antibiotic era?.
        Arch Med Res. 2005; 36: 697-705
        • Oderda M
        • Marra G
        • Albisinni S
        • et al.
        Accuracy of elastic fusion biopsy in daily practice: results of a multicenter study of 2115 patients.
        Int J Urol. 2018; 25: 990-997