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CT-guided transgluteal biopsy for systematic sampling of the prostate in patients without rectal access: a 13-year single-center experience

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Abstract

Objectives

The purpose of our study was to examine the safety and diagnostic utility of transgluteal CT-guided prostate biopsy for prostate sampling in patients without rectal access.

Methods

Seventy-three biopsies were performed in 65 patients over a 13-year period (2002–2015). Mean prostate-specific antigen (PSA) at biopsy was 7.8 ng/mL (range 0.37–31.5). Electronic medical records were reviewed for procedural details and complications. Mean PSA and number of cores in malignant and benign cohorts were compared with Student’s t test.

Results

Technical success rate was 97.3% (71/73; mean cores 8, range 3–28). Of these, 43.6% (31/71) yielded malignancy (mean Gleason score 7, range 6–10) and 56.3% (40/71) yielded benign tissue. The only complication was an asymptomatic periprostatic hematoma (1/73; 1.4%). In 14 patients who underwent surgery, Gleason scores were concordant in 71.4% (10/14) and discordant in 28.6% (4/14; Gleason 6 on biopsy but Gleason 7 on surgical specimen). Mean effective radiation dose was 18.5 mSv (median 15.0, range 4.4–86.2). There was no significant difference in either mean PSA (p = 0.06) or number of core specimens (p = 0.33) between malignant and benign cohorts.

Conclusion

CT-guided transgluteal prostate biopsy is highly safe and reliable for the detection of prostate cancer in men without rectal access.

Key Points

• Prostate cancer detection in men without rectal access is challenging.

• CT-guided transgluteal prostate biopsy is safe and effective in these patients.

• CT-guided biopsy may be particularly effective in diagnosing high-grade prostate cancer.

• Unilateral CT-guided biopsy may be effective in patients with focal lesions.

• The radiation exposure with this technique is acceptable.

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Abbreviations

PSA:

Prostate-specific antigen

USA:

United States of America

USPSTF:

United States Preventive Services Task Force

TRUS:

Transrectal ultrasound

IBD:

Inflammatory bowel disease

DLP:

Dose length product

RRP:

Radical retropubic prostatectomy

PIN:

Prostatic intraepithelial neoplasia

GIST:

Gastrointestinal stromal tumour

DRE:

Digital rectal examination

SIR:

Society of Interventional Radiology

HIPAA:

Health Insurance Portability and Accountability Act

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Acknowledgements

The scientific guarantor of this publication is Ajit Goenka. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Michael C. Olson, Thomas D. Atwell, Bernard F. King, Timothy Welch & Ajit H. Goenka

  2. Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Lance A. Mynderse

Authors
  1. Michael C. Olson
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  2. Thomas D. Atwell
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  3. Lance A. Mynderse
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  4. Bernard F. King
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  5. Timothy Welch
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  6. Ajit H. Goenka
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Correspondence to Michael C. Olson.

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Olson, M.C., Atwell, T.D., Mynderse, L.A. et al. CT-guided transgluteal biopsy for systematic sampling of the prostate in patients without rectal access: a 13-year single-center experience. Eur Radiol 27, 3326–3332 (2017). https://doi.org/10.1007/s00330-016-4694-7

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  • DOI: https://doi.org/10.1007/s00330-016-4694-7

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