Ces Urol 2021, 25(1):27-34 | DOI: 10.48095/cccu2021001

Transperineal prostate biopsy navigated with US/MRI fusion

Kateřina Ryšánková^{1, 2}, Pavla Hanzlíková^{3, 4}, Adéla Vrtková^{5, 6}, Tereza Albínová¹, Matěj Jendřejek¹, Jan Krhut^{1, 2}

¹ Urologická klinika Fakultní nemocnice Ostrava, Ostrava - Poruba

² Katedra chirurgických oborů LF Ostravské univerzity, Ostrava - Vítkovice

³ Ústav radiodiagnostický Fakultní nemocnice Ostrava, Ostrava - Poruba

⁴ Ústav zobrazovacích metod LF Ostravské univerzity, Ostrava - Vítkovice

⁵ Katedra aplikované matematiky, Fakulta elektrotechniky a informatiky, VŠB - Technická univerzita Ostrava, Ostrava - Poruba

⁶ Útvar náměstka ředitele pro vědu a výzkum, Fakultní nemocnice Ostrava, Ostrava - Poruba

Major statement: US/MRI fusion transperineal prostate biopsy has comparable yield and lower risk of infectious complications than transrectal biopsy. Purpose: Nowadays, prostate biopsies performed transperineally are gaining prominence. In our cohort, we retrospectively evaluated the yield of transperineally performed biopsies and at the same time their safety, especially with regard to infectious complications.

Patients and methods: From January 2019 to March 2020, we performed 208 fusion US/MRI guided prostate biopsies - transperineally. Magnetic resonance imaging was evaluated by the PI-RADS vs 2 and vs 2.1 scoring systems, respectively. In biopsy naive patients we performed systematic biopsy from the peripheral zone and took at least three samples from the lesion described by the radiologist. In patients with repeated biopsy, we made a targeted biopsy with at least three samples from the lesion or lesions PI-RADS ≥ 3, but we did not make a systematic biopsy.

Results: The overall yield of the method in our group, regardless of the PI-RADS score, was 52.9 % of proven cancers in biopsy naive patients, of which 35.3 % were clinically insignificant and 17.6 % were clinically significant. In rebiopsy, 53.6 % of cancers were detected, of which 38.6 % were clinically insignificant and 15 % were clinically significant When comparing the yield according to the PI-RADS score, in the PI-RADS 3 group a total of 68.5 % were negative, 31.5 % positive (27.8 % insignificant and 3.7 % significant), in the PI-RADS 4 group it was 44.3 % negative and 55.7 % positive (41.8 % and 13.9 %, respectively), in the PI-RADS 5 group 22.9 % negative, 77.1 % positive (43.8 % and 33.3 %, respectively). There was a statistically significant difference in the yield of biopsies (Chi-square test of independence for contingency tables, P < 0.001). We also assessed the complications of the procedure and we found that 182 patients underwent the procedure without any complications. As our main outcome measure, infectious complications, we recorded only two patients with dysuria, but without evidence of bacterial infection.

Conclusion: The yield of transperineally performed prostate biopsy in our cohort corresponds to literature data. We have noticed a minimum of complications, and therefore we believe that biopsy performed this way is a safe alternative.

Keywords: Diagnostic, fusion MRI/US prostate biopsy, transperineal prostate biopsy, urinary tract infection.

Received: November 6, 2020; Revised: December 13, 2020; Accepted: January 4, 2021; Prepublished online: January 4, 2021; Published: March 30, 2021