Transperineal Free-hand mpMRI Fusion-targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single-center Prospective Study

Urology. 2020 Jun:140:122-131. doi: 10.1016/j.urology.2019.11.078. Epub 2020 Feb 13.

Abstract

Objective: To evaluate the feasibility of "in-office" TPFBx under local anesthesia (LA).

Materials and methods: We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of prostate cancer (CaP), according to predefined exclusion criteria.

Results: We included 459 men (TPFBx n = 279 including n = 338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n = 180). Median procedural time and maximum pain were 19 minutes and 5 numeric rating scale (NRS) points; pain was highest at the time of LA. Only 1 major complication occurred (Clavien 3a). Hematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and 1 case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (P = .86 and P = .89). In comparison with TPSBx the sole differences were pain during prostatic sampling (P = .03), duration of hematospermia (P <.0001) and procedural time (P <.001) all higher for TPFBx. Clinically significant (cs) CaP was detected in n = 150 (53.8%) patients in the TPFBx group (34.9%, 51.7%, and 75% of Pirads 3, 4, and 5, respectively). Addition of systematic cores detected n = 25 csCaP that were missed by targeted cores (17.4% of all csCaP).

Conclusion: TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csCaP detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.

MeSH terms

  • Aged
  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / methods
  • Ambulatory Surgical Procedures / statistics & numerical data
  • Anesthesia, Local / methods
  • Feasibility Studies
  • Hematuria* / diagnosis
  • Hematuria* / etiology
  • Hemospermia* / diagnosis
  • Hemospermia* / etiology
  • Humans
  • Image-Guided Biopsy* / adverse effects
  • Image-Guided Biopsy* / methods
  • Image-Guided Biopsy* / statistics & numerical data
  • Italy / epidemiology
  • Male
  • Multimodal Imaging / methods
  • Multiparametric Magnetic Resonance Imaging / methods*
  • Pain, Procedural / prevention & control
  • Penile Erection
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / physiopathology
  • Postoperative Complications* / prevention & control
  • Prostate* / diagnostic imaging
  • Prostate* / pathology
  • Prostatic Neoplasms / epidemiology
  • Prostatic Neoplasms / pathology*
  • Ultrasonography, Interventional / methods*
  • Urination