Advertisement

Comparative Effectiveness and Tolerability of Transperineal MRI-Targeted Prostate Biopsy under Local versus Sedation

      Abstract

      Objectives

      To assess the prostate cancer diagnostic yield, complications, and costs of transperineal prostate biopsies when performed with local anesthesia versus sedation.

      Methods

      Data were prospectively collected for men undergoing transperineal MRI-targeted biopsy at the outpatient clinic and tertiary hospital of a single center between October 2017 to February 2020. These data included demographic, procedural, and pathologic variables and complications. Time-driven activity-based costing was performed to compare procedural costs.

      Results

      126 men were included. Age, BMI and PSA were similar for local (n = 45) vs sedation (n = 81), all P>0.05. Detection of clinically significant prostate cancer (CSPC) on combined systematic and targeted biopsy was similar for local vs sedation (24% vs 36%; P = 0.2). Local had lower detection on targeted biopsies alone (8.9% vs 25%; P = 0.03). However, fewer targeted cores were obtained per region of interest with local vs sedation (median 3 vs 4 cores; P<0.01). For local vs sedation, the complication rate was 2.6% and 6.1% (P = 0.6). The median visual analog pain score for local vs sedation was 3/10 vs 0/10 (P<0.01). The mean procedure time for local vs sedation was 22.5 vs 17.5 minutes (48.3 minutes when including anesthesia time). Time-driven activity-based costs for local vs sedation were $961.64 vs $2208.16 (P<0.01).

      Conclusion

      Transperineal biopsy with local anesthesia is safe with comparable outcomes to sedation. While the number of cores taken differed, there was no statistical difference in the detection of clinically significant cancer.

      Abbreviations:

      CSPC (Clinically significant prostate cancer), GG (Gleason grade group), mpMRI (Multiparametric magnetic resonance imaging), PI-RADS (Prostate imaging reporting & data system), ROI (Region of interest), TDABC (Time-driven activity-based costing)
      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

        • Chang DTS
        • Challacombe B
        • Lawrentschuk N.
        Transperineal biopsy of the prostate—is this the future?.
        Nat Rev Urol. 2013; 10: 690-702https://doi.org/10.1038/nrurol.2013.195
        • Liss MA
        • Ehdaie B
        • Loeb S
        • et al.
        An update of the american urological association white paper on the prevention and treatment of the more common complications related to prostate biopsy.
        J Urol. 2017; 198: 329-334https://doi.org/10.1016/j.juro.2017.01.103
        • 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: 384-388https://doi.org/10.1111/bju.12536
        • Shen P-F
        • Zhu Y-C
        • Wei W-R
        • et al.
        The results of transperineal vs transrectal prostate biopsy: a systematic review and meta-analysis.
        Asian J Androl. 2012; 14: 310-315https://doi.org/10.1038/aja.2011.130
        • Lo KL
        • Chui KL
        • Leung CH
        • et al.
        Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy.
        Hong Kong Med J Xianggang Yi Xue Za Zhi. 2019; 25: 209-215https://doi.org/10.12809/hkmj187599
        • Xue J
        • Qin Z
        • Cai H
        • et al.
        Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis.
        Oncotarget. 2017; 8: 23322-23336https://doi.org/10.18632/oncotarget.15056
        • Kawakami S
        • Yamamoto S
        • Numao N
        • Ishikawa Y
        • Kihara K
        • Fukui I.
        Direct comparison between transrectal and transperineal extended prostate biopsy for the detection of cancer.
        Int J Urol Off J Jpn Urol Assoc. 2007; 14: 719-724https://doi.org/10.1111/j.1442-2042.2007.01810.x
        • McGrath S
        • Christidis D
        • Clarebrough E
        • et al.
        Transperineal prostate biopsy – tips for analgesia.
        BJU Int. 2017; 120: 164-167https://doi.org/10.1111/bju.13859
        • 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.
        Urol. 2018; 115: 8-13https://doi.org/10.1016/j.urology.2018.01.021
        • Kum F
        • Elhage O
        • Maliyil J
        • et al.
        Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting.
        BJU Int. 2018; 15 (Published online November): 244-253https://doi.org/10.1111/bju.14620
        • Dekalo S
        • Matzkin H
        • Mabjeesh NJ.
        High cancer detection rate using cognitive fusion - targeted transperineal prostate biopsies.
        Int Braz J Urol Off J Braz Soc Urol. 2017; 43: 600-606https://doi.org/10.1590/S1677-5538.IBJU.2016.0511
      1. 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(3):311-317. doi:10.1038/pcan.2017.13

        • Oberlin DT
        • Casalino DD
        • Miller FH
        • et al.
        Diagnostic value of guided biopsies: fusion and cognitive-registration magnetic resonance imaging vs conventional ultrasound biopsy of the prostate.
        Urology. 2016; 92: 75-79https://doi.org/10.1016/j.urology.2016.02.041
        • Puech P
        • Rouvière O
        • Renard-Penna R
        • et al.
        Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US–MR Fusion guidance vs systematic biopsy—prospective multicenter study.
        Radiology. 2013; 268: 461-469https://doi.org/10.1148/radiol.13121501
        • Tzeng M
        • Cricco-Lizza E
        • Awamlh BAHA
        • et al.
        IDEAL Stage 2a experience with in-office, transperineal MRI/ultrasound software fusion targeted prostate biopsy.
        BMJ Surg Interv Health Technol. 2019; 1: 1-7https://doi.org/10.1136/bmjsit-2019-000025
        • Kosarek CD
        • Mahmoud AM
        • Eyzaguirre EJ
        • et al.
        Initial series of magnetic resonance imaging (MRI)-fusion targeted prostate biopsy using the first transperineal targeted platform available in the USA.
        BJU Int. 2018; 122: 909-912https://doi.org/10.1111/bju.14206
        • Kaplan RS
        • Anderson SR.
        Time-driven activity-based costing.
        Harv Bus Rev. 2004; 82 (150): 131-138
        • Grummet J
        • Gorin MA
        • Popert R
        • et al.
        TREXIT 2020”: why the time to abandon transrectal prostate biopsy starts now.
        Prostate Cancer Prostatic Dis. 2020; 13 (Published online): 1-4https://doi.org/10.1038/s41391-020-0204-8
      2. Prostate MRI and MRI-targeted biopsy in patients with prior negative biopsy - american urological association. 2020. Available at:https://www.auanet.org/guidelines/prostate-mri-and-mri-targeted-biopsy

        • Kenigsberg AP
        • Renson A
        • Rosenkrantz AB
        • et al.
        Optimizing the number of cores targeted during prostate magnetic resonance imaging fusion target biopsy.
        Eur Urol Oncol. 2018; 1: 418-425https://doi.org/10.1016/j.euo.2018.09.006
        • Nassiri N
        • Natarajan S
        • Margolis DJ
        • Marks LS.
        Targeted prostate biopsy: lessons learned midst the evolution of a disruptive technology.
        Urology. 2015; 86: 432-438https://doi.org/10.1016/j.urology.2015.07.001
        • Merrick GS
        • Irvin S
        • Fiano R
        • Anderson R
        • Butler WM
        • Adamovich E
        Pathology and quality of life outcomes following office-based transperineal prostate biopsy.
        Urology. 2016; 94: 24-28https://doi.org/10.1016/j.urology.2016.04.020
        • Elkhoury FF
        • Felker ER
        • Kwan L
        • et al.
        Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive: the prospective assessment of image registration in the diagnosis of prostate cancer (PAIREDCAP) study.
        JAMA Surg. 2019; 154 (Published online June): 811-818https://doi.org/10.1001/jamasurg.2019.1734
        • Ha Chung B
        • Horie S
        • Chiong E
        The incidence, mortality, and risk factors of prostate cancer in Asian men.
        Prostate Int. 2019; 7: 1-8https://doi.org/10.1016/j.prnil.2018.11.001
        • Cepek J
        • Chronik BA
        • Lindner U
        • et al.
        A system for MRI-guided transperineal delivery of needles to the prostate for focal therapy.
        Med Phys. 2013; 40012304https://doi.org/10.1118/1.4773043
        • Marra G
        • Zhuang J
        • Marquis A
        • et al.
        Pain in men undergoing transperineal free-hand multiparametric magnetic resonance imaging fusion targeted biopsies under local anesthesia: outcomes and predictors from a multicenter study of 1,008 patients.
        J Urol. 2020; 204: 1209-1215https://doi.org/10.1097/JU.0000000000001234
        • Sonn GA
        • Natarajan S
        • Margolis DJA
        • et al.
        Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device.
        J Urol. 2013; 189: 86-91https://doi.org/10.1016/j.juro.2012.08.095
        • Sonn GA
        • Chang E
        • Natarajan S
        • et al.
        Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.
        Eur Urol. 2014; 65: 809-815https://doi.org/10.1016/j.eururo.2013.03.025
        • Tyson MD
        • Arora SS
        • Scarpato KR
        • Barocas D.
        Magnetic resonance-ultrasound fusion prostate biopsy in the diagnosis of prostate cancer.
        Urol Oncol Semin Orig Investig. 2016; 34: 326-332https://doi.org/10.1016/j.urolonc.2016.03.005
        • McCulloch P
        • Altman DG
        • Campbell WB
        • et al.
        No surgical innovation without evaluation: the IDEAL recommendations.
        Lancet Lond Engl. 2009; 374: 1105-1112https://doi.org/10.1016/S0140-6736(09)61116-8