UP-6 Clinical Outcomes and Detection Rates of Transperineal MRI/US Fusion Targeted Prostate Biopsy
Thursday June 27, 2019 from
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Nathan C. Wong, United States



New York Medical College


Clinical outcomes and detection rates of transperineal MRI/US fusion targeted prostate biopsy

Nathan C. Wong1, Vincent Wong1, Michael King1, Mitchell Fraiman1, Ross Bauer1, Muhammad Choudhury1, John Phillips1, Christopher Dixon1.

1Urology, New York Medical College, Valhalla, NY, United States

Background: Transperineal (TP) multiparametric magnetic resonance imaging (mpMRI) targeted prostate biopsy may offer advantages over transrectal approaches by minimizing infectious risks without compromising the detection of clinically significant prostate cancer.  We report our initial experience of men undergoing transperineal fusion MRI targeted prostate biopsy using a fixed arm (Steady ProTM) ultrasound platform and 3mm interval perineal grid (Koelis Trinity®).

Methods: We performed a retrospective review of the initial 200 consecutive subjects who fulfilled the criteria for TP MRI/ultrasound fusion targeted biopsy including: subjects with an elevated prostate-specific antigen and lesion on mpMRI. In addition to demographic variables, we assessed indications for biopsy, PIRADS v2 findings and the criteria for a ‘dominant lesion’, cancer detection rates of the MRI-dominant lesion, clinically significant cancers (defined as Gleason grade group (GGG) ≥2), procedure-related complications, and clinical outcomes of biopsy results.

Results: We assessed 200 subjects to represent the initial cohort. There was no patient who underwent biopsy for a normal MRI (PIRADS 1). There were 13/200 (6.5%), 59/200 (29.5%), 82/200 (41.0%), ad 46/200 (23.0%) men who had PIRADS 2, 3, 4, and 5 lesions, respectively. Overall, 113/200 (56.5%) subjects had a positive targetted biopsy for prostate cancer of a dominant PIRADS lesion including 71 men (35.5%) with ≥GG2. The median number of cores taken from the dominant lesion was 6 (IQR 4-8). The detection of both overall (23, 52, 54 and 76%) and clinically significant cancers (15, 22, 35 and 59%) increased from PIRADS 2 to 5. No patient developed sepsis.  

Conclusion: TP MRI targeted prostate biopsy offers a safe and accurate method for the detection of prostate cancer while mitigating the risk of life-threatening sepsis.

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