South Central Section of the AUA 2022

SCS AUA 2022: Initial Experience With Transperineal Micro-ultrasound-guided Prostate Biopsy

(  The recent introduction of high-resolution micro-ultrasound (microUS) guided prostate biopsy aims to improve the detection of clinically significant prostate cancer (CSCaP). While transrectal micro US-guided biopsy has been increasingly utilized, reported outcomes with the transperineal approach are scarce. The authors report a single institutional experience with transperineal micro US-guided prostate biopsy.

They reviewed our prospectively maintained database of consecutive patients who underwent transperineal micro US-guided biopsy with the ExactVu™platform (Exact Imaging, Markham, Canada) between February 2021 and July 2021. All biopsies were performed in the operating room under general anesthesia. The Prostate Risk Identification using Micro US (PRI-MUS) protocol was utilized to risk stratify prostate lesions, with PRI-MUS 3-5 defined as positive. Clinicopathologic outcomes were analyzed. CSCaP was defined as Gleason Grade Group ≥2.

A total of 60 patients underwent transperineal micro US-guided biopsy by six urologists. Of these, 49 were biopsy-naïve, while six had a prior negative biopsy and five were on active surveillance. Mean ± standard deviation (SD) age was 66.1 ± 7.7 years and PSA was 9.0 ± 7.7 ng/mL. Thirty-six patients underwent multiparametric magnetic resonance imaging (mpMRI) prior to biopsy, of which 22 patients were found to have PIRADS 3-5 lesions. CSCaP was identified in 29/60 (48.3%) of patients, including 4/12 (33.3%) of patients with a negative MRI. The sensitivity and specificity of PRI-MUS for the detection of CSCaP in targeted cores were 84.0% and 31.0%, respectively. There were no post-biopsy infections.

In summary, the present study represents one of the largest reported experiences with transperineal micro US-guided prostate biopsy. This novel modality yields a high detection rate and sensitivity for CSCaP with minimal patient morbidity. Further prospective studies comparing micro US-guided biopsy to other conventional biopsy methods are needed.

Presented by: Nicholas Pickersgill, MD, Washington University in St. Louis, Division of Urologic Surgery

Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological AssociationAnnual Meeting, September 6-10, 2022, Coronado, CA

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