PURPOSE:Evidence supports obtaining MRI before prostate biopsy. Deliverables of MRI include improving prostate cancer detection through targeting of MRI lesions and reducing the total number of biopsies by eliminating the need for nontargeted biopsy. Actionable Intelligence Metric (AIM) and Reduction Metric (ReM) have been proposed to quantify these 2 deliverables; however, this work was performed in the transrectal biopsy setting. To assess generalizability, we examined AIM and ReM in a large, multi-institutional cohort of men undergoing transperineal biopsy. MATERIALS AND METHODS:All patients undergoing concurrent MRI-targeted and systematic transperineal biopsy and maintained in prospective prostate cancer databases across 5 institutions were included. AIM is the percent of men in whom targeted biopsy detected a higher grade group compared with systematic biopsy alone. ReM is the proportion of men in whom systematic biopsy may be omitted. In addition to total cohort evaluations of AIM and ReM, subgroup analyses and multivariable logistic regression were performed. RESULTS:In total, 1,587 transperineal biopsies were analyzed; 797 (50%) had ≥ grade group 2 prostate cancer. AIM in the overall cohort was 27.4%, and ReM was 83.3%. When stratified by PIRADS score and prior biopsy status, AIM and ReM were > 25% and > 80%, respectively, across all subgroups. On multivariable logistic regression, PI-RADS 5 lesions and biopsies performed at institution D were predictive of higher rates of upgrading on systematic biopsy, while patients with a prior negative biopsies had a decreased likelihood of systematic upgrading. CONCLUSIONS:AIM and ReM can be applied in the transperineal setting to assess deliverables of MRI-targeted prostate biopsy. Targeted biopsies provided actionable information in 27% of men, while up to 17% of clinically significant cancer would be missed if systematic biopsy were omitted. Individualized assessment of patient risk tolerance is necessary if a targeted biopsy-alone approach is to be adopted.

Prostate cancer (CaP) remains the most diagnosed malignancy in men, and the incidence of high-grade disease at diagnosis is increasing [...]

African American men bear an unequal proportion of metastatic prostate cancer burden. The utilization of second-generation anti-androgens like abiraterone with androgen deprivation therapy (ADT) has become a standard therapy for metastatic prostate cancer. Thus, we aimed to examine the utilization of abiraterone with ADT in African American men with metastatic disease and determine whether disparities in its use exist. This is a retrospective study, using a multi-institutional regional collaborative prostate cancer database. We compared the use of ADT with abiraterone between African American men and non-African American men diagnosed with distantly metastatic prostate cancer from July 2015 to August 2022, using logistic regression and negative binomial regression. We identified 201 men with metastatic prostate cancer and of those, 28

OBJECTIVE:To assess perceptions, practice patterns, and barriers to adoption of transperineal prostate biopsy (TPBx) under local anesthesia. METHODS:Providers from Michigan urological surgery improvement collaborative (MUSIC) and Pennsylvania urologic regional collaborative (PURC) were administered an online survey to assess beliefs and educational needs regarding TPBx. Providers were divided into those who performed or did not perform TPBx. The MUSIC and PURC registries were queried to assess TPBx utilization. Descriptive analytics and bivariate analysis determined associations between provider/practice demographics and attitudes. RESULTS:Since 2019, TPBx adoption has increased more than 2-fold to 7.0% and 16% across MUSIC and PURC practices, respectively. Of 350 urologists invited to participate in a survey, a total of 91 complete responses were obtained with 21 respondents (23%) reported performing TPBx. Participants estimated the learning curve was <10 procedure for TPBx performers and non-performers. No significant association was observed between learning curve and provider age/practice setting. The major perceived benefits of TPBx were decreased risk of sepsis, improved cancer detection rate and antibiotic stewardship. The most commonly cited challenges to implementation included access to equipment and patient experience. Urologists performing TPBx reported learning curve as an additional barrier, while those not performing TPBx reported duration of procedure. CONCLUSION:Access to equipment and patient experience concerns remain substantial barriers to adoption of TPBx. Dissemination of techniques utilizing existing equipment and optimization of local anesthetic protocols for TPBx may help facilitate the continued adoption of TPBx.

Bladder stones represent approximately 5% of all cases of urolithiasis and are typically identified and managed long before causing irreversible renal injury. We present a case of a man in his 40s with a prior history of a gunshot wound to the abdomen who presented with leakage from a previously healed suprapubic tube tract and was found to have a giant bladder stone with a resulting renal injury. He subsequently underwent a combined open cystolithotomy and vesicocutaneous fistulotomy during his hospitalisation, which helped to improve his renal function. In addition to there being few reported cases of bladder stones >10 cm, this represents the first report in the literature of an associated decompressive ‘pop-off’ mechanism through a fistulised tract.

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) high-risk prostate cancer, based on the AUA guidelines. Amongst the low-risk patients, imaging utilization included pelvic MRI (59.7%), bone scan (17.8%), CT (16.0%), and PET-based imaging (0.5%). Redundant imaging occurred in 1022 patients (29.2%). There was variability among the PURC sites for imaging used in the low-risk patients, and iterative education reduced the need for CT and bone scans. Approximately 15% of low-risk patients had staging imaging performed using either a CT or bone scan, and redundant imaging occurred in almost one-third of men. Such data underscore the need for continued guideline-based education to optimize the stewardship of resources and reduce unnecessary costs to the healthcare system.

Purpose: Targeted prostate biopsies are increasingly being performed by urologists in the United States includingthose in the Pennsylvania Urologic Regional Collaborative, a physician-led data-sharing and quality improvement collaborative. To evaluate the performance of MRI guided fusion needle prostate biopsies in the collaborative, we analyzed the variability by practice in rates of detection of clinically significant prostate cancer and patient characteristics associated with detection of clinically significant prostate cancer. Methods: We analyzed 857 first-time MRI fusion biopsy procedures performed at five practices (minimum 20 procedures) between 2015 and 2019. We used chi-square analysis for baseline patient characteristics and Grade Group (GG) >= 3 tumor detection rates by practice. Multivariable logistic regression was used to estimate the odds of clinically significant cancer detection when adjusting for baseline patient characteristics. Results: Approximately 15% of men undergoing targeted MRI guided biopsy were <= 59 years old. Median prostate specific antigen (PSA) was 6.8 ng/ml. Detection rates for GG >= 3 tumors ranged from 14.3% to 28.3% (P = 0.02) across practices. However, the odds of GG >= 3 tumor detection did not differ significantly between practices after adjusting for clinical and radiographic factors. Overall, increased likelihood of detecting a GG >= 3 tumor was associated with increased age, DRE abnormalities, higher PSA, smaller gland volume and PI-RADS >= 4 MRI lesions. There was an 81% concordance rate between PI-RADS >= 4 and Gleason grade >= 3 prostate cancer. Conclusion: We demonstrate the value of obtaining pre-biopsy MRI given high concordance between presence of suspicious lesions and MRI-targeted biopsy detection of clinically significant prostate cancer. Variability of baseline patient characteristics among practices may account for the observed differences in clinically significant cancer detection rates. These findings can aid standardization and quality improvement efforts within the collaborative.

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-18 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER USING COGNITIVE VERSUS SOFTWARE-BASED MRI-TARGETING DURING TRANSPERINEAL PROSTATE BIOPSY: A MULTI-INSTITUTIONAL ANALYSIS Benjamin Rosenfeld, Dylan M. Buller, William E. Martin, Amanda Sherman, William C. Faust, Serge Ginzburg, Joseph R. Wagner, Alexander Kutikov, Andres F. Correa, Kevin Pinto, Chia-Ling Kuo, Lucas Godoy, Peter C. Albertsen, and Benjamin T. Ristau Benjamin RosenfeldBenjamin Rosenfeld , Dylan M. BullerDylan M. Buller , William E. MartinWilliam E. Martin , Amanda ShermanAmanda Sherman , William C. FaustWilliam C. Faust , Serge GinzburgSerge Ginzburg , Joseph R. WagnerJoseph R. Wagner , Alexander KutikovAlexander Kutikov , Andres F. CorreaAndres F. Correa , Kevin PintoKevin Pinto , Chia-Ling KuoChia-Ling Kuo , Lucas GodoyLucas Godoy , Peter C. AlbertsenPeter C. Albertsen , and Benjamin T. RistauBenjamin T. Ristau View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A randomized trial in the transrectal prostate biopsy setting demonstrated no difference in detection of clinically significant prostate cancer (csPC) whether targeted biopsy (TB) of MRI lesions was performed using cognitive or software-based fusion (PMID 30522912). Retrospective data suggests similar lack of difference in the transperineal biopsy (TP-B) setting (PMID 33207137); however, prior analyses have not accounted for the impact of TP-B indication (biopsy naïve (BN), prior negative biopsy (PNB), active surveillance (AS)). We examined a large, multi-institutional cohort of men to assess differences in detection of csPC between cognitive and software-based TB stratified by TP-B indication. METHODS: Prospectively maintained TP-B databases across five institutions were retrospectively analyzed. All patients with PIRADS 3-5 lesions on MRI undergoing TB of the index lesion(s) were included. Baseline demographic and clinical data were captured. Primary outcome was detection of csPC (≥GG2) within a TB stratified by biopsy indication (BN, PNB, and AS) and whether cognitive or software-based fusion was used. Univariate and multivariate statistical analyses were performed. RESULTS: 1,546 TP-B (804 cognitive, 742 software) were included. Median age was 66 y, median PSA 6.9 ng/ml, and median prostate volume 48 cc. 758 were BN, 254 had PNB, and 510 were on AS. Overall csPC detection on TB was 40.9%. On multivariable analysis, there was no significant difference in detection of csPC between cognitive and software-based TB overall (OR 1.15, 95% CI 0.85-1.55, p=0.38). Stratified by biopsy indication, software-based targeting improved detection of csPC in the PNB population (OR 5.02, 95% CI 1.71-16.5, p<0.01). There was no significant difference for BN (OR 0.78, 95% CI 0.52-1.17, p=0.23) or AS (OR 1.59, 95% CI 0.92-2.79, p=0.10). CONCLUSIONS: In a large, multi-institutional cohort undergoing TB of suspicious MRI lesions, we found no significant difference overall in detection of csPC whether a cognitive or software-based technique was used. When stratified by biopsy indication, this lack of difference persisted for BN and AS patients; however, software-based fusion outperformed cognitive fusion in the PNB population. Source of Funding: Unfunded © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e790 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin Rosenfeld More articles by this author Dylan M. Buller More articles by this author William E. Martin More articles by this author Amanda Sherman More articles by this author William C. Faust More articles by this author Serge Ginzburg More articles by this author Joseph R. Wagner More articles by this author Alexander Kutikov More articles by this author Andres F. Correa More articles by this author Kevin Pinto More articles by this author Chia-Ling Kuo More articles by this author Lucas Godoy More articles by this author Peter C. Albertsen More articles by this author Benjamin T. Ristau More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSEThere is significant interest in identifying complete responders to neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) to potentially avoid removal of a pathologically benign bladder. However, clinical restaging after NAC is highly inaccurate. The objective of this study was to develop a next-generation sequencing-based molecular assay using urine to enhance clinical staging of patients with bladder cancer.METHODSUrine samples from 20 and 44 patients with bladder cancer undergoing RC were prospectively collected for retrospective analysis for molecular correlate analysis from two clinical trials, respectively. The first cohort was used to benchmark the assay, and the second was used to determine the performance characteristics of the test as it correlates to responder status as measured by pathologic examination.RESULTSFirst, to benchmark the assay, known mutations identified in the tissue (MT) of patients from the Accelerated Methotrexate, Vinblastine, Doxorubicin, Cisplatin trial (ClinicalTrials.gov identifier: NCT01611662, n = 16) and a cohort from University of California-San Francisco (n = 4) were cross referenced against mutation profiles from urine (MU). We then determined the correlation between MU persistence and residual disease in pre-RC urine samples from a second prospective clinical trial (The pT0 trial; ClinicalTrials.gov identifier: NCT02968732). Residual MU status correlated strongly with residual disease status (pT0 trial; n = 44; P = .0092) when MU from urine supernatant and urine pellet were assessed separately and analyzed in tandem. The sensitivity, specificity, PPV, and NPV were 91%, 50%, 86%, and 63% respectively, with an overall accuracy of 82% for this second cohort.CONCLUSIONMU are representative of MT and thus can be used to enhance clinical staging of urothelial carcinoma. Urine biopsy may be used as a reliable tool that can be further developed to identify complete response to NAC in anticipation of safe RC avoidance.

You have accessJournal of UrologyCME1 Apr 2023MP12-13 DISPARITIES IN PROSTATE MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING UTILIZATION IN BIOPSY NAIVE MEN Aroh Pandit, Tamir Sholklapper, Johnathan Drevik, and Serge Ginzburg Aroh PanditAroh Pandit More articles by this author , Tamir SholklapperTamir Sholklapper More articles by this author , Johnathan DrevikJohnathan Drevik More articles by this author , and Serge GinzburgSerge Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multi-parametric magnetic resonance imaging (mpMRI) prior to prostate biopsy has been recommended by the American Urologic Society (AUA) since 2019. Studies have shown biopsy naive men in minority groups are less likely to undergo mpMRI. We aimed to evaluate national trends in mpMRI utilization in biopsy naive men. METHODS: The TriNetX US Collaborative Network database of 90,863,999 patients was retrospectively queried using current procedure terminology codes for prostate biopsy and prostate mpMRI with associated dates. One cohort contained men with prostate biopsy without prior mpMRI. A second cohort contained men with biopsy and mpMRI prior. Inclusion was restricted to biopsies performed in 2017 or later. Men were excluded if they had a documented biopsy prior to 2017, or if pre-biopsy prostate specific antigen (PSA) was greater than or equal to 20ng/dL to exclude metastatic disease at presentation. Data was stratified by race, ethnicity, and region. Uni-variable logistic regression modeling was performed to evaluate the likelihood of using mpMRI prior to biopsy, odds ratios (OR) with 95% confidence intervals (CI) not crossing 1 were considered statistically significant. RESULTS: 49,590 men met inclusion for analysis, of which 39% had a pre-biopsy mpMRI. Compared to White men, Black and American Indian or Alaska Native men had a 15% and 39% lower likelihood of using mpMRI, respectively. Compared to non Hispanic men, Hispanic or Latino men had a 45% lower likelihood of using mpMRI. Men in the South and West had a 10% and 48% lower likelihood of using mpMRI, respectively, compared to men in the Northeast. CONCLUSIONS: In this nationwide clinical study, men in minority groups were less likely to undergo pre prostate biopsy mpMRI compared to men in majority groups. Additionally, men in the South and West were less likely to undergo pre prostate biopsy compared to men in the Northeast. Limitations include the retrospective nature and lack of inter-institutional standardization of coding. Further research is warranted to study the causation of these disparities. Source of Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e138 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aroh Pandit More articles by this author Tamir Sholklapper More articles by this author Johnathan Drevik More articles by this author Serge Ginzburg More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer.Methods and analysis We will perform a multicentre, prospective randomised clinical trial to compare transperineal versus transrectal prostate biopsy for elevated prostate-specific antigen in the first biopsy, prior negative biopsy and active surveillance biopsy setting. Prostate MRI will be performed prior to biopsy, and targeted biopsy will be conducted for suspicious MRI lesions in addition to systematic biopsy (12 cores). Approximately 1700 men will be recruited and randomised in a 1:1 ratio to transperineal versus transrectal biopsy. A streamlined design to collect data and to determine trial eligibility along with the two-stage consent process will be used to facilitate subject recruitment and retention. The primary outcome is postbiopsy infection, and secondary outcomes include other adverse events (bleeding, urinary retention), pain/discomfort/anxiety and critically, detection of non-low-grade (grade group ≥2) prostate cancer.Ethics and dissemination The Institutional Review Board of the Biomedical Research Alliance of New York approved the research protocol (protocol number #18-02-365, approved 20 April 2020). The results of the trial will be presented at scientific conferences and published in peer-reviewed medical journals.Trial registration number NCT04815876.

This study aims to determine if there is a difference in prostate cancer nomogram-adjusted risk of biochemical recurrence (BCR) and/or adverse pathology (AP) between African American (AAM) and Caucasian men (CM) undergoing radical prostatectomy (RP). A retrospective review was performed of men undergoing RP in the Pennsylvania Urologic Regional Collaborative between 2015 and 2021. Cox proportional hazard regression models were used to compare the rate of BCR after RP, and logistic regression models were used to compare rates of AP after RP between CM and AAM, adjusting for the CAPRA, CAPRA-S, and MSKCC pre- and post-operative nomogram scores. Rates of BCR and AP after RP were analyzed from 3190 and 5029 men meeting inclusion criteria, respectively. The 2-year BCR-free survival was lower in AAM (72.5%) compared to CM (79.0%), with a hazard ratio (HR) of 1.38 (95% CI 1.16–1.63, p < 0.001). The rate of BCR was significantly greater in AAM compared to CM after adjustment for MSKCC pre-op (HR 1.29; 95% CI 1.08–1.53; p = 0.004), and post-op nomograms (HR 1.26; 95% CI 1.05–1.49; p < 0.001). There was a trend toward higher BCR rates among AAM after adjustment for CAPRA (HR 1.13; 95% CI 0.95–1.35; p = 0.17) and CAPRA-S nomograms (HR 1.11; 95% 0.93–1.32; p = 0.25), which did not reach statistical significance. The rate of AP was significantly greater in AAM compared to CM after adjusting for CAPRA (OR 1.28; 95% CI 1.10–1.50; p = 0.001) and MSKCC nomograms (OR 1.23; 95% CI 1.06–1.43; p = 0.007). This analysis of a large multicenter cohort provides further evidence that AAM may have higher rates of BCR and AP after RP than is predicted by CAPRA and MSKCC nomograms. Accordingly, AAM may benefit with closer post-operative surveillance and may be more likely to require salvage therapies.

Objective: Multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized in prostate cancer (CaP) diagnosis and staging. While Level 1 data supports MRI utility in CaP diagnosis, there is less data on staging utility. We sought to evaluate the real-world accuracy of mpMRI in staging localized CaP. Materials and Methods: Men who underwent radical prostatectomy (RP) for CaP in 2021 at our institution were identified. Sensitivity, specificity, positive predictive value and negative predictive value of mpMRI in predicting pT2N0 organ confined disease, extracapsular extension , seminal vesicle invasion , lymph node involvement, and bladder neck invasion were evaluated. Associations between MRI accuracy and AUA risk stratification (AUA RS), MRI institution (MRI-I), MRI strength (1.5 vs. 3T) (MRI-S), and MRI timing (MRI-T) were assessed. These analyses were repeated using Pennsylvania Urologic Regional Collaborative (PURC) data. Results: Institutional and community mpMRI CaP staging data demonstrated poor sensitivity (2.9%-49.2%% vs. 16.8%-24.4%), positive predictive value (40%-100% vs. 35.8%-68.2%), and negative predictive value (56.3%-94.3% vs. 68.4%-96.2%) in predicting surgical pathologic features - in contrast, specificity (89.1%-100% vs. 93.9%-98.6%) was adequate. mpMRI accuracy for extracapsular extension, seminal vesicle invasion, and lymph node involvement was significantly (p < 0.001) associated with AUA RS. There was no association between mpMRI accuracy and MRI-I, MRI-S, and MRI-T. Conclusion: Despite enthusiasm for its use, in a real-world setting, mpMRI appears to be a poor staging study for localized CaP and is unreliable as the sole means of staging patients prior to prostatectomy. mpMRI should be used cautiously as a staging tool for CaP, and should be interpreted considering individual patient risk strata. (c) 2023 The Author(s). Published by Elsevier Inc.

Kevin B. Ginsburg, Johnathan Drevik, Jared P. Schober, Alberto A. Castro Bigalli, Jeffrey L. Ellis*, Avery Braun, Kaynaat Syed, Philadelphia, PA; John Danella, Danville, PA; Serge Ginzburg, Philadelphia, PA; Laurence Belkoff, Bala Cynwyd, PA; Adam C. Reese, Philadelphia, PA; Jeffrey Tomaszewski, Camden, NJ; Edouard Trabulsi, Phiadelphia, PA; Eric A. Singer, New Brunswick, NJ; Bruce Jacobs, Pittsburgh, PA; Jay D. Raman, Hershey, PA; Thomas Guzzo, Robert G. Uzzo, Marc C. Smaldone, Andres F. Correa, Philadelphia, PA

You have accessJournal of UrologyCME1 May 2022V11-05 DEVICE-FREE, TWO-SITE ENTRY TRANSPERINEAL ULTRASOUND-GUIDED PROSTATE BIOPSY UTILIZING 14-GAUGE ANGIOCATHETERS Nicklaus Houston, Johnathan Drevik, Serge Ginzburg, and Alexander Kutikov Nicklaus HoustonNicklaus Houston More articles by this author , Johnathan DrevikJohnathan Drevik More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002632.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy provides several advantages over the historical transrectal approach. These include a lower risk of post-biopsy sepsis, reduced risk of rectal bleeding, a lower barrier to cognitive targeting, easier targeting of anterior lesions, and antibiotic stewardship. One of the barriers to adoption among urologists is lack of training and education in this approach. Commercial devices to couple ultrasound (US) probes to biopsy needles have been developed and marketed to urologists. However, these add substantial cost and limit degrees of movement. Here we provide an educational video showing a feasible, cost-neutral office based transperineal prostate biopsy approach. METHODS: In this video we demonstrate our technique for device-free office based transperineal prostate biopsy utilizing a 12 core template and two angiocatheters as access sites. We review positioning, equipment, anesthesia strategies and the biopsy technique. RESULTS: We begin the video with discussion of table setup and templates used by our practice. We then show our method of angiocatheter insertion following anesthetization of the two biopsy tracts with injection at the periapical triangle. Finally, we demonstrate our biopsy and handoff practices. Essential to our device-free technique is the ability to direct the US probe and biopsy needle. To do this reliably we hold the biplanar US parallel to the superior-inferior(horizontal) axis of the prostate without moving it off midline, visualizing the urethra in the sagittal plane as the guiding landmark. We then insert the biopsy needle parallel to the probe while simultaneously utilizing shallow twists of the probe in the clockwise-counterclockwise direction. This dynamic scanning assures proper identification of the needle tip and not its more proximal shaft while slightly pivoting the needle to biopsy sites. Throughout this procedure, we take great care to maintain the probe’s alignment in the same horizontal plane to keep proper orientation. This technique also allows for anterior-posterior pivoting without needing to establish additional entry sites. CONCLUSIONS: This video provides education on how to perform an in office transperineal prostate biopsy using readily available equipment in a general urology practice. It highlights key features of transperineal prostate biopsies and provides a framework for urologists looking to learn or adopt this biopsy technique without incurring any additional significant costs over the transrectal approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e922 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicklaus Houston More articles by this author Johnathan Drevik More articles by this author Serge Ginzburg More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement PDF DownloadLoading ...

Background: Prostate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry. Methods: Transrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications. Results: Of 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02-1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding. Conclusion: Non-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy. (C) 2022 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.

You have accessJournal of UrologyCME1 May 2022MP58-11 COMPARISON OF PROSTATE CANCER DETECTION RATES BETWEEN TRANS-RECTAL MRI/US FUSION AND TRANS-PERINEAL COGNITIVE TARGETED PROSTATE BIOPSY APPROACHES Johnathan Drevik, Zafardjan Dalimov, Allen Rojhani, Phillip Abbosh, Steven Sterious, Joshua Cohn, Jay Simhan, Justin Friedlander, Eric Ghiraldi, Robert Uzzo, and Serge Ginzburg Johnathan DrevikJohnathan Drevik More articles by this author , Zafardjan DalimovZafardjan Dalimov More articles by this author , Allen RojhaniAllen Rojhani More articles by this author , Phillip AbboshPhillip Abbosh More articles by this author , Steven SteriousSteven Sterious More articles by this author , Joshua CohnJoshua Cohn More articles by this author , Jay SimhanJay Simhan More articles by this author , Justin FriedlanderJustin Friedlander More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Serge GinzburgSerge Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many urology practices have access to MRI/US fusion technology for prostate targeting via transrectal (TR) approach. The adoption of transperineal (TP) prostate biopsy is increasing, but conversion to TP fusion technology can be financially prohibitive. Cognitive TP targeting is a cost-effective alternative but may be perceived as a barrier and assumed to result in lower cancer detection. We describe a single surgeon’s transition from TR MRI/US fusion to cognitive TP targeted biopsies. METHODS: A retrospective chat review of patients that underwent targeted prostate biopsy (either TP cognitive or TR MRI/US fusion) from 2015 - 2021 was performed. Patients with PSA > 20, concomitant procedures or metastatic disease were excluded. In patients with multiple biopsies only the first targeted biopsy was abstracted. Chi-Square and Mann-Whitney tests were utilized for univariable analysis of categorical and continuous variables, respectively. Multivariable logistic regression models were fit to evaluate variables associated with clinically significant prostate cancer on targeted biopsy. RESULTS: Of the 146 patients that underwent targeted prostate biopsy, 40% underwent TP cognitive approach. Clinicopathologic characteristics between the two groups differed in demographic distribution, prostate size, and MRI findings (Table 1). The detection of any prostate cancer (64% vs 39%, p=0.003) and clinically significant prostate cancer (csPCa) (48% vs 19%, p<0.001) were higher in the TP cognitive targeted group. On multivariable analysis, controlling for clinicopathologic characteristics, only PSA density above >0.15 ng/ml2 was associated with csPCa on targeted biopsy (Table 2). Targeted biopsy approach, TR fusion vs. TP cognitive targeted biopsy, was not associated with detection of csPCa. CONCLUSIONS: Clinically significant prostate cancer detection rate was not compromised when switching from transrectal MRI/US fusion to transperineal cognitive targeted biopsy technique. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e996 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Drevik More articles by this author Zafardjan Dalimov More articles by this author Allen Rojhani More articles by this author Phillip Abbosh More articles by this author Steven Sterious More articles by this author Joshua Cohn More articles by this author Jay Simhan More articles by this author Justin Friedlander More articles by this author Eric Ghiraldi More articles by this author Robert Uzzo More articles by this author Serge Ginzburg More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:Prostate MRI detecting PI-RADs = 3 lesions has low diagnostic utility for prostate malignancy. Use of PSA density has been suggested to further risk-stratify these men, to potentially avoid biopsies in favor of monitoring. We evaluate the ability of PSA density (PSAd) to risk-stratify PIRADs 3 lesions across patients who underwent a prostate biopsy in a large multi-institutional collaborative. MATERIALS AND METHODS:Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement collaborative of 11 academic and community urology practices in Pennsylvania and New Jersey. A retrospective analysis was performed on all patients in the PURC database that had a prostate MRI with PI-RADs 3 lesions only. PSA just before the MRI and prostate size reported on MRI were used to calculate the PSA. Clinicopathologic data were evaluated. Univariable analysis using Chi-Square and Kruskal Wallis tests and multivariable logistic regression were used to identify predictors of any PCa, and clinically significant prostate cancer (csPCa) was defined as ≥ Grade Group 2 (GG2.) RESULTS: Between May 2015 and March 2021, 349 patients with PIRADs 3 lesions only were identified and comprised the cohort of interest. Median PSA was 5.0 with a prostate volume of 58cc and a median PSA density of 0.11, 10.6% of the cohort was African American with 81.4% being Caucasian. Significant prostate cancer was detected in 70/349 (20.0%) men. Smaller prostate volume, abnormal DRE, and higher PSAd were significantly associated with clinically significant prostate cancer on univariable analysis. In men with PSAd <0.15, 31/228 (13.6%) harbored csPCa. Multivariable analysis confirmed that men with PSAd >0.15 were more likely to harbor clinically significant prostate cancer (P < 0.001). CONCLUSION:Across a large regional collaborative, patients with PIRADs 3 lesions on mpMRI were noted to have clinically significant cancer in 20% of biopsies. Using a PSA density cut-off of 0.15 may result in missing clinically significant prostate cancer in 13.6%. This information is useful for prebiopsy risk stratification and counseling.