Are outpatient transperineal prostate biopsies without antibiotic prophylaxis equivalent to standard transrectal biopsies for patient safety and cancer detection rates?A retrospective cohort study in 222 patients

Abstract Background To describe our experience with outpatient transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods In our retrospective review, we compared the TPB to TRB in our institution for outpatient prostate biopsies with local anesthesia from June 1st, 2017 to June 1st, 2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion Outpatient TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

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A Comparison of Infectious Outcomes Between In-Office Transperineal Prostate Biopsies Without Antibiotic Prophylaxis and Transrectal Prostate Biopsies

10.21203/rs.3.rs-444956/v1 ◽

2021 ◽

Author(s):

Majdee Islam ◽

Rodrigo Donalisio Da Silva ◽

Alan Quach ◽

Diedra Gustafson ◽

Leticia Nogueira ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Prophylaxis ◽

Cancer Detection ◽

Retention Rate ◽

Daily Practice ◽

Oral Antibiotics ◽

Prostate Biopsies ◽

Transrectal Biopsy ◽

Post Procedure ◽

Significant Difference

Abstract Background: To describe our experience with office-based transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods: In our retrospective review, we compared the TPB to TRB in our institution for in-office prostate biopsies with local anesthesia from 06/2017-06/2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results: Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion: In-office TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

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Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI

Prostate Cancer ◽

10.1155/2020/4626781 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Maudy C. W. Gayet ◽

Anouk A. M. A. van der Aa ◽

Harrie P. Beerlage ◽

Bart Ph Schrier ◽

Maaike Gielens ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rates ◽

Prostate Biopsies ◽

Significant Difference ◽

Significant Pathology ◽

Study Population ◽

Clinically Significant ◽

Control Study

Objective. To compare prostate cancer detection rates (CDRs) and pathology results with targeted prostate biopsy (TB) and systematic prostate biopsy (SB) in biopsy-naive men. Methods. An in-patient control study of 82 men undergoing SB and subsequent TB in case of positive prostate MRI between 2015 and 2017 in the Jeroen Bosch Hospital, the Netherlands. Results. Prostate cancer (PCa) was detected in 54.9% with 70.7% agreement between TB and SB. Significant PCa (Gleason score ≥7) was detected in 24.4%. The CDR with TB and SB was 35.4% and 48.8%, respectively (p=0.052). The CDR of significant prostate cancer with TB and SB was both 20.7%. Clinically significant pathology upgrading occurred in 7.3% by adding TB to SB and 22.0% by adding SB to TB. Conclusions. There is no statistically significant difference between CDRs of SB and TB. Both SB and TB miss significant PCas. Moreover, pathology upgrading occurred more often by adding SB to TB than vice versa. This indicates that the omission of SB in this study population might not be justified.

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3D versus 2D Systematic Transrectal Ultrasound-Guided Prostate Biopsy: Higher Cancer Detection Rate in Clinical Practice

Prostate Cancer ◽

10.1155/2013/783243 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Alexandre Peltier ◽

Fouad Aoun ◽

Fouad El-Khoury ◽

Eric Hawaux ◽

Ksenija Limani ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Transrectal Ultrasound ◽

Daily Practice ◽

Cancer Detection Rate ◽

Prior History ◽

Detection Rates ◽

Significant Difference

Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice.Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol.Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% (P<0.05). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection.Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol.

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A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists Versus a Senior Consultant in a Real World-setting

10.21203/rs.3.rs-120286/v1 ◽

2020 ◽

Author(s):

Jiaao Song ◽

Bi-ming He ◽

Hu-sheng Li ◽

Zhen-kai Shi ◽

Guan-yu Ren ◽

...

Keyword(s):

Specific Antigen ◽

Daily Practice ◽

Secondary Outcome ◽

Complication Rates ◽

Detection Rates ◽

Prostate Biopsies ◽

Significant Difference ◽

Procedural Time ◽

Practice Method ◽

A Prospective Study

Abstract Background: Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study was to compare the PCa detection rate and peri- and post-operative complications of PB among three residents and a consultant.Methods: A total of 343 patients who underwent PB between August 2018 with July 2019 were involved in this study. Residents were systematically trained two weeks by the consultant for performing systemic biopsy (SB) and targeted biopsy (TB). And then, three residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and post-operative data was prospectively collected. The primary outcome and secondary outcome were to compare the PCa-detection rates and complications between residents and consultant, respectively. Results: There was no significant difference between the residents and consultant in terms of overall PCa-detection rates of SB, TB or further stratified by prostate specific antigen value, prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores compared with residents (175 cores versus 86 to 114 cores, P=0.043) and shorter procedural time versus residents (mean 16 min versus 19.7 to 20.1 min, P <0.001). The complication rate for consultant was 6.7%, and 5% to 8.2% for residents, respectively (P = 0.875).Conclusions: The residents could get a similar PCa detection and complication rates compared with the consultant after a two-week training. However, the residents still need more cases to shorten the time of biopsy procedure.

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A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists versus a Senior Consultant in a Real-World Setting

Urologia Internationalis ◽

10.1159/000518493 ◽

2021 ◽

pp. 1-7

Author(s):

Jia-ao Song ◽

Bi-ming He ◽

Hu-sheng Li ◽

Xiao-wen Yu ◽

Zhen-kai Shi ◽

...

Keyword(s):

Specific Antigen ◽

Daily Practice ◽

Secondary Outcome ◽

Complication Rates ◽

Detection Rates ◽

Prostate Biopsies ◽

Significant Difference ◽

Procedural Time ◽

Practice Method ◽

A Prospective Study

Introduction: Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study aimed to compare the PCa detection rates and peri- and postoperative complications of PB among 3 residents and a consultant. Patients and Methods: A total of 343 patients who underwent PB between August 2018 and July 2019 were involved in this study. Residents were systematically trained for 2 weeks by a consultant for performing systematic biopsy (SB) and targeted biopsy (TB). And then, 3 residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and postoperative data were collected from a prospectively maintained database (www.pc-follow.cn). The primary outcome and secondary outcome were to compare the PCa detection rates and complications between the residents and consultant, respectively. Results: There was no significant difference between the residents and consultant in terms of overall PCa detection rates of SB and TB or further stratified by prostate-specific antigen value and prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores (175 cores vs. 86–114 cores, p = 0.043) and shorter procedural time (mean 16 min vs. 19.7–20.1 min, p < 0.001) versus the residents. The complication rate for the consultant was 6.7% and 5%–8.2% for the residents, respectively (p = 0.875). Conclusions: The residents could get similar PCa detection and complication rates compared with that of the consultant after a 2-week training. However, the residents still need more cases to shorten the time of the biopsy procedure.

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Changes in prostate cancer detection rate of fusion versus systematic biopsy over time: A single center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.15 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 15-15

Author(s):

Brian P. Calio ◽

Abhinav Sidana ◽

Dordaneh Sugano ◽

Amit L Jain ◽

Mahir Maruf ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Learning Curves ◽

Low Risk ◽

Fusion Biopsy ◽

Detection Rates ◽

Single Center Experience ◽

Significant Difference ◽

Clinically Significant ◽

Systematic Biopsy

15 Background: To determine the effect of learning curves and changes in fusion platform during 9 years of NCI’s experience with multiparametric MRI (mpMRI)/TRUS fusion biopsy. Methods: A review was performed of a prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007−2016. The patients were stratified based on the timing of first biopsy in 3 groups. Cohort 1 included patients biopsied between 7/2007−12/2010, accounting for learning curve at our institution. Cohort 2 included patients biopsied from 1/2011 up to the debut of UroNav (Invivo) platform in 5/2013. Cohort 3 included patients biopsied after 5/2013. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. Cancer detection rates (CDR) between Sbx and Fbx during different time periods were compared using McNemar’s test. Age and PSA standardized CDRs were calculated for comparison between 3 cohorts. Results: 1528 patients were included in the study with 219, 549 and 761 patients included in 3 respective cohorts. Mean age, PSA and race distribution were similar across 3 cohorts. In cohort 1 there was no significant difference between CDR of CS disease by Fbx (24.7%) vs Sbx (21.5%), p = 0.377. Fbx was significantly better than Sbx in detection of CS disease in cohort 2 and cohort 3 (31.5% vs 25.3%, p = 0.001; 36.5% vs 30.2%, p < 0.001, respectively). There was significant decline in detection of low risk disease by Fbx compared to Sbx in the same period (cohort 2: 14.2% vs 20.9%, p < 0.001; cohort 3: 12.5% vs 19.5%, p < 0.001). Age and PSA standardized CDR of CS cancer by Fbx increased significantly between each successive cohort (cohort 1 and 2: 5.2%, 95% CI [2.1-8.5]), 2 and 3 (5.2%, 95% CI [1.8-8.6]). Conclusions: Our results show that after an early learning period using Fbx, CS prostate cancer was detected at significantly higher rates with Fbx than with Sbx, and low risk disease was detected at lower rates. Advances in software allowed for even greater detection of CS disease in the last cohort. This study shows that accuracy of Fbx is dependent on multiple factors; surgeon/radiologist experience and software improvements together produce improved accuracy.

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Are all biopsies created equal? comparison of extended sextant prostate biopsies performed with and without MRI-TRUS fusion biopsy system.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.117 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 117-117

Author(s):

Graham R. Hale ◽

Jonathan Bloom ◽

Vikram Sabarwal ◽

Samuel Gold ◽

Kareem Rayn ◽

...

Keyword(s):

Cancer Detection ◽

Clinical Stage ◽

Time Intervals ◽

Fusion Biopsy ◽

Detection Rates ◽

Inherent Risk ◽

Prostate Biopsies ◽

Benign Pathology ◽

Under Sampling ◽

Systematic Biopsy

117 Background: Extended sextant systematic prostate biopsies have the inherent risk of under-sampling prostate cancer. Fusion guided multiparametric magnetic resonance imaging (mpMRI) biopsies have been employed to better represent the disease and guide treatment. We sought to determine if due to heightened suspicion of cancer and/or visualization of mpMRI there were any discrepancies between systematic biopsies done with a Fusion System as compared to those done without (TRUS alone). Methods: From a prospectively collected database, we performed a review collecting age, race, clinical stage, PSA, and time until repeat systematic biopsy as part of fusion guided biopsy (IB). We also collected pathology results reported as Gleason Score (GS), for both the patients’ OB and our IB. Patients were stratified into groups based on time between OB and IB/fusion biopsy ( < 6 months, < 1 year and < 2 years). Results: 69 patients with a previous OB underwent combined fusion and IB within our designated time intervals. Cancer detection rates between the OB and IB results were similar at 6 months, 1 year and 2 years (80 vs 90%, 87.5 vs 87.5% and 65 vs 69%). Detection rates of GS ≥ 3+4 were higher with IB within 12 months compared with IB from 12-24 months (72.7 vs 40.9%, p = 0.03 OR 3.85 (1.09-13.66). Of the patients who were upgraded (n = 24), 54.2% (n = 13) went from benign pathology to a diagnosis of prostate adenocarcinoma. Of all OB GS 3+3 (n = 31), 29% were restaged to higher risk disease on IB. Rates of IB upgrading were similar within 6 months, 1 year and 2 year, 40%, 33.33% and 31.91%). Patients who were upgraded on IB compared to those who were not upgraded were of similar age (67.0 ± 6.53 vs 66.50 ± 6.47), race (17.4% African-American vs 13%), PSA (7.60 ± 5.61 vs 7.50 ± 4.39) and prostate volume on MRI (51.30 ± 26.87 vs 59.26 ± 38.52). Conclusions: A systematic biopsy at our referral center during a mpMRI fusion biopsy was over 3.5 times more likely to detect GS ≥ 3+4 when done within 1 year of the outside biopsy. There continued to be a risk, 34.7% overall, of disease upgrading in all time periods. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH

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2100 CANCER DETECTION RATES ON MR / ULTRASOUND (US) FUSED IMAGE GUIDED PROSTATE BIOPSIES DIRECTLY CORRELATES WITH MULTI-PARAMETRIC MRI

The Journal of Urology ◽

10.1016/j.juro.2010.02.2174 ◽

2010 ◽

Vol 183 (4S) ◽

Cited By ~ 1

Author(s):

Paul H. Chung ◽

Ardeshir R. Rastinehad ◽

Angelo A. Baccala ◽

Jochen Kruecker ◽

Sheng Xu ◽

...

Keyword(s):

Cancer Detection ◽

Detection Rates ◽

Image Guided ◽

Prostate Biopsies ◽

Fused Image

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846 MRI/US FUSION PROSTATE BIOPSIES: CANCER DETECTION RATES

The Journal of Urology ◽

10.1016/j.juro.2011.02.667 ◽

2011 ◽

Vol 185 (4S) ◽

Cited By ~ 4

Author(s):

Ardeshir Rastinehad ◽

Jochen Kruecker ◽

Compton Benjamin ◽

Paul Chung ◽

Baris Turkbey ◽

...

Keyword(s):

Cancer Detection ◽

Detection Rates ◽

Prostate Biopsies

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Complications and Prostate Cancer Diagnosis Rate of TRUS Prostate Biopsies Using 16 and 18G Needles by Clavien Scoring

Urologia Journal ◽

10.5301/uj.5000238 ◽

2017 ◽

Vol 84 (4) ◽

pp. 236-239 ◽

Cited By ~ 1

Author(s):

Serkan Ozcan ◽

Mehmet Akif Diri ◽

Murat Bagcioglu ◽

Tolga Karakan ◽

Arif Aydın

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Daily Basis ◽

Cancer Detection Rate ◽

Detection Rates ◽

Prostate Biopsies ◽

Group 2 ◽

Group 1

Aim We aimed to compare the 18 and 16-Gauge (G) needles used in transrectal ultrasonography (TRUS)-guided needle biopsy for cancer detection rates and complications using the Clavien Scoring System. Materials and Methods The 80 patients who were included in the study were randomized and divided into two groups. Group 1 (n = 36) had a TRUS-guided prostate biopsy with an 18G needle and Group 2 had a 16G needle (n = 44). The hematuria, bleeding assessment, and infection events were evaluated on a daily basis. These complications were graded according to the Clavien Scoring. Results In Group 1, only five (13%) patients were diagnosed with prostate cancer, and three patients were reported to have atypical small acinar proliferation (ASAP). In Group 2, 16 (36%) patients were diagnosed with prostate cancer and one patient was reported to have ASAP. The difference in the prostate cancer detection rate between the groups was statistically significant. According to the Clavien grading system, the complications were at the Grade 1 level in 25 people in Group 1 in 29 people in Group 2. Grade 2 level complications were not observed in either group. While one person was Grade 3 in Group 1, two people in Group 2 had this rate. There were no significant differences between the groups. Conclusions We found that cancer detection rate increased by increasing the thickness of the needle used in TRUS-guided prostate biopsy without any increase in the complications.

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