Transurethral (TURP) biopsy of suspected anterior prostate cancers identified by multi-parametric MRI: a pilot study of a novel technique.

Objective To describe a novel biopsy technique which involves performing a cognitively-directed transurethral resection of the prostate (TURP) to diagnose suspected anterior prostate cancers (APC) detected by multi-parametric magnetic resonance imaging (mpMRI) in patients with prior negative transrectal ultrasound (TRUS) guided biopsies.

Methods This is a prospective study in which participants aged 50-75 were offered inclusion if they had an elevated prostate-specific antigen (PSA) level, a lesion suspicious for APC on mpMRI, and at least one prior negative TRUS-guided prostate biopsy. Prostatic mpMRI was acquired with a 3-Tesla machine without endorectal coil. Preoperative review of the mpMRI images was used to target the suspected APC on TURP biopsy. The primary outcome was the detection rate of clinically significant prostate cancer, defined as the presence of any Gleason pattern ≥ 4 in the specimen. Secondary outcomes included biopsy-related complications including 30-day readmissions. Results A total of 16 consecutive participants were enrolled. Median age was 64 years, median PSA was 12. 4 ng/ml and participants had a median of 2 prior negative TRUS-guided biopsies. Thirteen (81. 3%) participants had clinically significant APCs detected by TURP biopsy. One participant was readmitted within 30-days post-procedure for continuous bladder irrigation. Seven participants (43. 8%) underwent radical prostatectomy which confirmed clinically significant disease in all 7 participants. Conclusion Among participants with anterior prostate lesions on mpMRI and prior negative TRUS-biopsy, TURP-biopsy does detect some clinically significant cancers. This study serves as a proof of concept and further comparative trials are needed prior to widespread adoption.

Urology. 2016 Feb 01 [Epub ahead of print]

Shawn Dason, Christopher B Allard, Ian Wright, Bobby Shayegan

Division of Urology, McMaster University, Hamilton, ON, Canada. Division of Urology, McMaster University, Hamilton, ON, Canada. , Division of Urology, McMaster University, Hamilton, ON, Canada. , Division of Urology, McMaster University, Hamilton, ON, Canada.

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