Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach

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Title: Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach
Author(s): Bass, EJ
Donaldson, IA
Freeman, A
Jameson, C
Punwani, S
Moore, C
Arya, M
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: Background: Despite high rates of disease misclassification and sepsis, the use of transrectal biopsy remains commonplace. Transperineal mapping biopsies mitigate these problems but carry increased cost and patient burden. Local anaesthetic, multiparametric magnetic resonance imaging (MRI)-targeted transperineal biopsy may offer an alternative. Here, we aim to determine the feasibility, tolerability and detection rates of clinically significant prostate cancer using a local anaesthetic, transperineal, MRI-targeted biopsy technique. Methods: Tertiary referral centre in which 181 consecutive men underwent local anaesthetic, transperineal MRI-targeted prostate biopsy (September 2014 to January 2016). A standardized local anaesthetic technique was used to obtain targeted biopsies using visual estimation with the number of targeted cores determined by each of a number of users. We assessed adverse events, patient visual analogue pain scores and detection rates of clinically significant cancer (defined by University College London (UCL) definitions one and two and separately by the presence of dominant and non-dominant Gleason pattern 4). We secondarily assessed detection of any cancer, rates of detection by MRI (Likert) score and by presenting PSA. Differences were assessed using Chi-squared tests (P<0.05). Results: One hundred eighty-one men with 243 lesions were included. There were no episodes of sepsis or re-admissions and one procedure was abandoned owing to patient discomfort. Twenty-three out of 25 (92%) men would recommend the procedure to another. Median visual analogue pain score was 1.0 (interquartile range: 0.0–2.4). A total 104/181 (57%) had UCL definition 1 disease (Gleason ⩾4+3 and/or maximum cancer length ⩾6 mm) and 129/181 (71%) had UCL definition 2 cancer (Gleason ⩾3+4 and/or maximum cancer length ⩾4 mm). Fifty-four out of 181 (30%) and 124/181 (69%) had dominant and non-dominant pattern 4 disease or greater (irrespective of cancer length). Any cancer was detected in 142/181 (78%). Significant disease was more likely in higher MRI-scoring lesions and in men with PSAs ⩾10 ng ml−1. Conclusions: This approach to prostate biopsy is feasible, tolerable and can be performed in ambulatory settings.
Publication Date: 9-May-2017
Date of Acceptance: 22-Feb-2017
URI: http://hdl.handle.net/10044/1/53872
DOI: https://dx.doi.org/10.1038/pcan.2017.13
ISSN: 1365-7852
Publisher: Nature Publishing Group
Start Page: 311
End Page: 317
Journal / Book Title: Prostate Cancer and Prostatic Diseases
Volume: 20
Issue: 3
Copyright Statement: Copyright © 2017, Rights Managed by Nature Publishing Group
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Urology & Nephrology
MULTIPARAMETRIC MRI
MAPPING BIOPSIES
CANCER
RISK
PERFORMANCE
STANDARD
MEN
Science & Technology
Life Sciences & Biomedicine
Oncology
Urology & Nephrology
MULTIPARAMETRIC MRI
MAPPING BIOPSIES
CANCER
RISK
PERFORMANCE
STANDARD
MEN
1112 Oncology And Carcinogenesis
Urology & Nephrology
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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