Skip to main content

Advertisement

SpringerLink
Log in

Transperineal prostate biopsy with cognitive magnetic resonance imaging/biplanar ultrasound fusion: description of technique and early results

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Objective

To describe our technique and early results performing transperineal prostate biopsy using cognitive magnetic resonance imaging (MRI)/biplanar ultrasound fusion. Key components of this technique include use of the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD) and simultaneous transrectal ultrasound guidance in the axial and sagittal planes.

Patients and methods

In total, 95 patients (38 studied retrospectively and 57 studied prospectively) underwent a transperineal MRI-targeted prostate biopsy using the technique detailed in this manuscript. All biopsies were performed by a single urologist (MAG). Data were collected with respect to cancer detection rates, tolerability, and complications. The subset of patients who were studied prospectively was assessed for complications by telephone interviews performed at 4–6 days and 25–31 days following the prostate biopsy.

Results

Between February 2018 and June 2019, 95 men underwent a transperineal prostate biopsy using MRI/biplanar ultrasound fusion guidance. Patients had a total of 124 PI-RADS 3–5 lesions that were targeted for biopsy. In total, 108 (87.1%) lesions were found to harbor prostate cancer of any grade. Grade group ≥ 2 prostate cancer was found in 81 (65.3%) of targeted lesions. The detection rates for grade group ≥ 1 and grade group ≥ 2 prostate cancer rose with increasing PI-RADS score. In 65 (68.4%) cases, the patient’s highest grade prostate cancer was found within an MRI target. Additionally, 12 of 55 (21.8%) patients who were found to have no or grade group 1 prostate cancer on systematic biopsy were upgraded to grade group ≥ 2 prostate cancer with MRI targeting. Only 1 (1.1%) patient received periprocedural antibiotics and no patient experienced an infectious complication. Self-limited hematuria and hematospermia were commonly reported following the procedure (75.4% and 40.4%, respectively) and only 1 (1.1%) patient developed urinary retention.

Conclusions

We demonstrate the safety and feasibility of performing transperineal prostate biopsy using cognitive MRI/biplanar ultrasound fusion guidance. The described technique affords the safety benefits of the transperineal approach as well as obviates the need for a formal fusion platform. Additionally, this method can conveniently be performed under local anesthesia with acceptable tolerability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ghabili K, Tosoian JJ, Schaeffer EM et al (2016) The history of prostate cancer from antiquity: review of paleopathological studies. Urology 97:8–12

    Article  Google Scholar 

  2. Soloway MS, Obek C (2000) Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol 163:172–173

    Article  CAS  Google Scholar 

  3. Pareek G, Armenakas NA, Fracchia JA (2001) Periprostatic nerve blockade for transrectal ultrasound guided biopsy of the prostate: a randomized, double-blind, placebo controlled study. J Urol 166:894–897

    Article  CAS  Google Scholar 

  4. Liss MA, Ehdaie B, Loeb S et al (2017) 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 198:329–334

    Article  Google Scholar 

  5. Borghesi M, Ahmed H, Nam R et al (2017) Complications after systematic, random, and image-guided prostate biopsy. Eur Urol 71:353–365

    Article  Google Scholar 

  6. Roberts MJ, Bennett HY, Harris PN et al (2017) Prostate biopsy-related infection: a systematic review of risk factors, prevention strategies, and management approaches. Urology 104:11–21

    Article  Google Scholar 

  7. Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X (2019) Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis. World J Surg Oncol 17:31

    Article  Google Scholar 

  8. McGrath S, Christidis D, Clarebrough E et al (2017) Transperineal prostate biopsy-tips for analgesia. BJU Int 120:164–167

    Article  Google Scholar 

  9. Chang DT, Challacombe B, Lawrentschuk N (2013) Transperineal biopsy of the prostate–is this the future? Nat Rev Urol 10:690–702

    Article  Google Scholar 

  10. Meyer AR, Joice GA, Schwen ZR, Partin AW, Allaf ME, Gorin MA (2018) Initial experience performing in-office ultrasound-guided transperineal prostate biopsy under local anesthesia using the precision point transperineal access system. Urology 115:8–13

    Article  Google Scholar 

  11. Kum F, Elhage O, Maliyil J et al (2018) Initial outcomes of local anaesthetic freehand transperineal biopsies in the outpatient setting. BJU. https://doi.org/10.1111/bju.14620

    Article  Google Scholar 

  12. Ristau BT, Allaway M, Cendo D et al (2018) Free-hand transperineal prostate biopsy provides acceptable cancer detection and minimizes risk of infection: evolving experience with a 10-sector template. Urol Oncol 36(528):e15–e20

    Google Scholar 

  13. Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822

    Article  Google Scholar 

  14. Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med 378:1767–1777

    Article  Google Scholar 

  15. Rouviere O, Puech P, Renard-Penna R et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20:100–109

    Article  Google Scholar 

  16. van der Leest M, Cornel E, Israel B et al (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 75:570–578

    Article  Google Scholar 

  17. Turkbey B, Rosenkrantz AB, Haider MA et al (2019) Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 76:340–351

    Article  Google Scholar 

  18. Epstein JI, Amin MB, Reuter VE, Humphrey PA (2017) Contemporary Gleason grading of prostatic carcinoma: an update with discussion on practical issues to implement the 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 41:e1–e7

    Article  Google Scholar 

  19. Tomlinson D, von Baeyer CL, Stinson JN, Sung L (2010) A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 126:e1168–e1198

    Article  Google Scholar 

  20. Swan JS, Ying J, Stahl J et al (2010) Initial development of the Temporary Utilities Index: a multiattribute system for classifying the functional health impact of diagnostic testing. Qual Life Res 19:401–412

    Article  Google Scholar 

  21. Swan JS, Hur C, Lee P, Motazedi T, Donelan K (2013) Responsiveness of the testing morbidities index in colonoscopy. Value Health 16:1046–1053

    Article  Google Scholar 

  22. Swan JS, Kong CY, Hur C et al (2015) Comparing morbidities of testing with a new index: screening colonoscopy versus core-needle breast biopsy. J Am Coll Radiol 12:295–301

    Article  Google Scholar 

  23. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    Article  Google Scholar 

  24. Liu W, Patil D, Howard DH et al (2018) Adoption of prebiopsy magnetic resonance imaging for men undergoing prostate biopsy in the United States. Urology 117:57–63

    Article  Google Scholar 

  25. Wegelin O, van Melick HHE, Hooft L et al (2017) Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 71:517–531

    Article  Google Scholar 

  26. Gross MD, Alshak MN, Shoag JE et al (2019) Healthcare costs of post-prostate biopsy sepsis. Urology. https://doi.org/10.1016/j.urology.2019.06.011

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA

    Michael A. Gorin, Alexa R. Meyer, Michael Zimmerman, Rana Harb, Gregory A. Joice, Zeyad R. Schwen & Mohamad E. Allaf

Authors
  1. Michael A. Gorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexa R. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rana Harb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregory A. Joice
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeyad R. Schwen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohamad E. Allaf
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MAG: protocol/project development, data analysis, and manuscript writing/editing. ARM: protocol/project development, data analysis, and manuscript writing/editing. MZ: data collection or management and manuscript writing/editing. RH: data collection or management and manuscript writing/editing. GAJ: protocol/project development and manuscript writing/editing. ZRS: protocol/project development and manuscript writing/editing. MEA: protocol/project development, data analysis and manuscript writing/editing.

Corresponding author

Correspondence to Michael A. Gorin.

Ethics declarations

Conflict of interest

The authors have no conflicts of interests to disclose.

Ethical approval

Patients in the retrospective cohort were studied following Institutional Review Board Approval with a waiver of consent (Protocol # IRB00198333). Patients in the prospective cohort signed informed consent for study participation (Protocol # IRB00138687). No animals were used in the course of this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gorin, M.A., Meyer, A.R., Zimmerman, M. et al. Transperineal prostate biopsy with cognitive magnetic resonance imaging/biplanar ultrasound fusion: description of technique and early results. World J Urol 38, 1943–1949 (2020). https://doi.org/10.1007/s00345-019-02992-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02992-4

Keywords

Search

Navigation