Skip to main content

Advertisement

SpringerLink
Log in

Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis

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

Abstract

Purpose

The aim of this study was to assess the post biopsy infection rate, feasibility and prostate cancer (PCa) detection rate (CDR) by performing transperineal MRI-TRUS fusion biopsy of the prostate (TPBx) under local anesthesia (LA) without antibiotic prophylaxis (AP).

Methods

We prospectively screened 766 men with suspicious lesions on mpMRI, an elevated PSA level or a suspect digital examination undergoing MRI-TRUS-TPBx in LA, from May 2019 to July 2020. Patients with the need for antibiotic prophylaxis or without a PI-RADS target lesion were excluded from final analyses. We reported CDR, perioperative pain (0–10) and postoperative complications. PCa with an ISUP grade ≥ 2 was classified as clinically significant PCa (csPCa).

Results

We included 621 patients with a median age of 68 years (IQR 62–74), a PSA of 6.43 ng/mL (IQR 4.72–9.91) and a prostate volume of 45 cc (IQR 32–64). In median, 4 targeted (TB) (IQR 3–4) and 6 (IQR 5–7) systematic biopsies (SB) detected in combination overall 416 (67%) PCa and 324 (52%) csPCa. Overall CDR of TB for PI-RADS 3, 4 and 5 was 26%, 65% and 84%, respectively. Patients reported a median perioperative pain level of 2 (IQR 1–3). Four patients (0.6%) developed a post biopsy infection, one experienced urosepsis.

Conclusion

Our results demonstrate that transperineal MRI-TRUS fusion-guided prostate biopsy under LA without AP is feasible, safe and well tolerated.

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

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, [KG], upon reasonable request.

Abbreviations

AP:

Antibiotic prophylaxis

CDR:

Cancer detection rate

csPCa:

Clinically significant prostate cancer

IQR:

Interquartile range

LA:

Local anesthesia

mpMRI:

Multiparametric magnetic resonance imaging

PCa:

Prostate cancer

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

Prostate-specific antigen; SB: systematic biopsy

TB:

Targeted biopsy

TBx:

Transperineal prostate biopsies

TRUS:

Transrectal ultrasound

UTI:

Urinary tract infections

References

  1. 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. https://doi.org/10.1016/S0140-6736(16)32401-1

    Article  PubMed  Google Scholar 

  2. Brown LC, Ahmed HU, Faria R et al (2018) Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: the PROMIS study. Health Technol Assess (Rockv). https://doi.org/10.3310/hta22390

    Article  Google Scholar 

  3. Hadaschik BA, Kuru TH, Tulea C et al (2011) A novel stereotactic prostate biopsy system integrating pre-interventional magnetic resonance imaging and live ultrasound fusion. J Urol. https://doi.org/10.1016/j.juro.2011.07.102

    Article  PubMed  Google Scholar 

  4. van der Leest M, Cornel E, Israël 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-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol. https://doi.org/10.1016/j.eururo.2018.11.023

    Article  PubMed  Google Scholar 

  5. Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. https://doi.org/10.1056/nejmoa1801993

    Article  PubMed  Google Scholar 

  6. Rouvière 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. https://doi.org/10.1016/S1470-2045(18)30569-2

    Article  PubMed  Google Scholar 

  7. Radtke JP, Kuru TH, Boxler S et al (2015) Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol. https://doi.org/10.1016/j.juro.2014.07.098

    Article  PubMed  Google Scholar 

  8. Baco E, Ukimura O, Rud E et al (2015) Magnetic resonance imaging-transectal ultrasound image-fusion biopsies accurately characterize the index tumor: correlation with step-sectioned radical prostatectomy specimens in 135 patients. Eur Urol. https://doi.org/10.1016/j.eururo.2014.08.077

    Article  PubMed  Google Scholar 

  9. Cash H, Maxeiner A, Stephan C et al (2016) The detection of significant prostate cancer is correlated with the Prostate Imaging Reporting and Data System (PI-RADS) in MRI/transrectal ultrasound fusion biopsy. World J Urol. https://doi.org/10.1007/s00345-015-1671-8

    Article  PubMed  Google Scholar 

  10. Robert Koch-Institut and the Society of the epidemiological cancer registries in Germany (2019) Cancer in Germany for 2015/2016. https://doi.org/10.25646/5977.2

  11. Bruyère F, Malavaud S, Bertrand P et al (2015) Prosbiotate: a multicenter prospective analysis of infectious complications after prostate biopsy. J Urol. https://doi.org/10.1016/j.juro.2014.07.086

    Article  PubMed  Google Scholar 

  12. Wagenlehner FME, Van Oostrum E, Tenke P et al (2013) Infective complications after prostate biopsy: outcome of the global prevalence study of infections in urology (GPIU) 2010 and 2011 a prospective multinational multicentre prostate biopsy study. Eur Urol. https://doi.org/10.1016/j.eururo.2012.06.003

    Article  PubMed  Google Scholar 

  13. Lundström KJ, Drevin L, Carlsson S et al (2014) Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol. https://doi.org/10.1016/j.juro.2014.04.098

    Article  PubMed  Google Scholar 

  14. Raman J, Lin YK, Smith T et al (2011) 2129 Complications following prostate needle biopsy requiring hospital admission or ER visits - Experience from our last 1000 cases. J Urol. https://doi.org/10.1016/j.juro.2011.02.2326

    Article  PubMed  PubMed Central  Google Scholar 

  15. Korkmaz N, Gurbuz Y, Sandikci F, Kul G, Tutuncu EE, Sencan I (2020) The role of ciprofloxacin resistance and extended-spectrum beta-lactamase (ESBL) positivity in infective complications following prostate biopsy. Urol J 17(2):192–197. https://doi.org/10.22037/uj.v0i0.4755

    Article  PubMed  Google Scholar 

  16. EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2021. ISBN 978-94-92671-13-4

  17. Grummet JP, Weerakoon M, Huang S et al (2014) Sepsis and “superbugs”: Should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int. https://doi.org/10.1111/bju.12536

    Article  PubMed  Google Scholar 

  18. Pepdjonovic L, Tan GH, Huang S et al (2017) Zero hospital admissions for infection after 577 transperineal prostate biopsies using single-dose cephazolin prophylaxis. World J Urol. https://doi.org/10.1007/s00345-016-1985-1

    Article  PubMed  Google Scholar 

  19. Marra G, Zhuang J, Beltrami M et al (2020) MP20-04 feasibility and accuracy of transperineal free-hand mpMRI targeted prostate biopsies under local anesthesia. J Urol. https://doi.org/10.1097/ju.0000000000000853.04

    Article  Google Scholar 

  20. Stefanova V, Buckley R, Flax S et al (2019) transperineal prostate biopsies using local anesthesia: experience with 1,287 patients prostate cancer detection rate complications and patient tolerability. J Urol. https://doi.org/10.1097/JU.0000000000000156

    Article  PubMed  Google Scholar 

  21. Egevad L, Delahunt B, Srigley JR, Samaratunga H (2016) International Society of Urological Pathology (ISUP) grading of prostate cancer – An ISUP consensus on contemporary grading. APMIS. https://doi.org/10.1111/apm.12533

    Article  PubMed  Google Scholar 

  22. Abughosh Z, Margolick J, Goldenberg SL et al (2013) A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol. https://doi.org/10.1016/j.juro.2012.09.121

    Article  PubMed  Google Scholar 

  23. Wegelin O, Exterkate L, van der Leest M et al (2019) Complications and adverse events of three magnetic resonance imaging-based target biopsy techniques in the diagnosis of prostate cancer among men with prior negative biopsies: results from the future trial, a multicentre randomised controlled trial. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2019.08.007

    Article  PubMed  Google Scholar 

  24. Kum F, Elhage O, Maliyil J et al (2020) Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting. BJU Int. https://doi.org/10.1111/bju.14620

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lee M, Setia S, Cole A et al (2018) MP26-07j In-office freehand transperineal template mapping biopsy performed under local anesthesia using a novel guide: feasible, safe, and effective for cancer detection. J Urol. https://doi.org/10.1016/j.juro.2018.02.865

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bass EJ, Donaldson IA, Freeman A et al (2017) Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach. Prostate Cancer Prostatic Dis. https://doi.org/10.1038/pcan.2017.13

    Article  PubMed  Google Scholar 

  27. Borghesi M, Ahmed H, Nam R et al (2017) Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. https://doi.org/10.1016/j.eururo.2016.08.004

    Article  PubMed  Google Scholar 

  28. Ahdoot M, Wilbur AR, Reese SE et al (2020) MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. https://doi.org/10.1056/nejmoa1910038

    Article  PubMed  PubMed Central  Google Scholar 

  29. Schoots IG, Roobol MJ, Nieboer D et al (2015) Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. https://doi.org/10.1016/j.eururo.2014.11.037

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany

    K. Günzel, A. Magheli, S. Heinrich, H. Neubert, J. Schlegel, T. Henkel & S. Hinz

  2. Department of Urology, Oslo University Hospital, Oslo, Norway

    E. Baco

  3. Department of Urology, University Hospital Magdeburg, Magdeburg, Germany

    H. Cash & M. Schostak

  4. Department of Radiology, Charité–Universitätsmedizin Berlin, Berlin, Germany

    P. Asbach

Authors
  1. K. Günzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Magheli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Baco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Cash
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Heinrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Neubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Schlegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Schostak
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T. Henkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Asbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Hinz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KG and SH were responsible for designing and writing the study protocol, inclusion of patients, extracting and analyzing data, interpreting results, statistical analysis, writing and revision of the manuscript. AM, SH, HN and JS were responsible for inclusion of patients, extracting and analysing data, interpreting results and critical revision of the manuscript. EB, SH, TH, PA and MS were responsible for data analysis and interpretation, critical revision of the manuscript and supervision.

Corresponding author

Correspondence to K. Günzel.

Ethics declarations

Ethical approval

Approval of the Ethics Committee for the Study was granted by the Berlin Medical Association.

Consent to participate

All patients have signed an informed consent for inclusion in the 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

Günzel, K., Magheli, A., Baco, E. et al. Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis. World J Urol 39, 3861–3866 (2021). https://doi.org/10.1007/s00345-021-03699-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-021-03699-1

Keywords

Search

Navigation