(UroToday.com) For the past three decades or more, transrectal ultrasound (TRUS) guided biopsy has been considered the standard diagnostic approach for the detection of prostate cancer. In the past few years, driven in large part by concerns regarding post-biopsy sepsis in patients undergoing TRUS procedures, transperineal biopsy has been increasingly utilized with equivalent cancer detection rate compared to TRUS biopsy. Concurrently, there has been an increasingly large role of pre-biopsy magnetic resonance imaging (MRI) with targeted biopsy. However, data on the detection rate, the tolerability, and the complications of mpMRI targeted fusion transperineal biopsy (TPFBx) under local anesthesia (LA) are limited and thus the relative merits of transperineal and transrectal routes for prostate biopsy are still debated. To better inform this discussion, in a moderated poster presentation at the American Urologic Association (2020) Virtual Annual Meeting, Giancarlo Marra, MD, and colleagues presented results of their study assessing mpMRI targeted fusion transperineal biopsy under local anesthesia.
The authors recruited patients treated at two tertiary referral institutions. Prior to prostate biopsy, they prospectively screened 1,327 men with a positive mpMRI who were scheduled to undergo TPFBx under LA between September 2016 and May 2019. Patients with a known history of prostate cancer, those over the age of 80 years, and those with a PSA >20 ng/ml were excluded.
For all biopsies, both targeted and systematic sampling was performed. Two definitions of clinically significant prostate cancer (CSPCa) were employed (D1: START criteria; D2: ISUP score >6). Peri-procedural pain (NRS), timings, erectile (IIEF-5), and urinary (IPSS) function and complications were evaluated and predictors of prostate cancer diagnosis were identified.
Among 1327 men screen, 1014 patients were included. The mean age was 66.8 ±7.4 years and the mean PSA was 8.1 ±4.1ng/mL. Among 1014 men, there were a total of 1424 mpMRI lesions.
Utilizing the START criteria for clinically significant prostate cancer, four-hundred men were diagnosed with CSPCa (39.4%) and 45 were diagnosed with nCSPCa (4.4%). As would be expected, increasing PIRAD score was associated with an increasing proportion of CSPCa: PIRADS 3, 4, and 5 corresponded to 15.4%, 46.2% and 73.9% CSPCa rate, respectively.
Procedure-associated pain was acceptable (NRS 3.1 ±2.3); total biopsy duration was 15.9 ±4.9 mins. No differences in pre- and post-biopsy erectile or urinary function were observed (p=0.45 and p=0.58), respectively. Complication rates were low (Clavien 2 n=1, Clavien >2 n=0) and no episodes of post-biopsy sepsis were identified.
Age, PSA density, DRE and PIRAD score were predictive of CSPCa diagnosis while a previous negative biopsy was associated with a decreased likelihood of CSPCa diagnosis, as highlighted in the following table:
Presented by: Giancarlo Marra, MD, University of Zurich, Zurich, Switzerland
Co-Authors: Junlong Zhuang, Mattia Beltrami, Giorgio Calleris, Xiaozhi Zhao, Alessandro Marquis, Yansheng Kan, Marco Oderda, Haifeng Huang, Riccardo Faletti, Qing Zhang, Luca Molinaro, Wei Wang, Laura Bergamasco, Stefano Tappero, Daniele D'Agate, Hongquian Guo, and Paolo Gontero
Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN, USA, Twitter: @WallisCJD, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020.