The results of transperineal versus transrectal prostate biopsy： a systematic review and meta-analysis

This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer （PCa） detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen （PSA） levels and digital rectal examination （DRE） findings. The Cochrane Collaboration＇s RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials （RCTs） and four casecontrol studies （CCS）, met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups （risk difference （RD）, -0.02; 95% confidence interval （CI）, -0.08-0.03; P=0.34）. Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group （RD, -0.01; 95% CI, -0.05-0.04; P=0.81）. There was no significant difference in PCa detection rate between the saturation TR and TP approaches （31.4% vs. 25.7%, respectively;P=0.3）. There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.

Endoclipping treatment of life-threatening rectal bleeding after prostate biopsy

Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.

Targeted prostate biopsy： value of multiparametric magnetic resonance imaging in detection of localized cancer

Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound （TRUS）-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging （mp-MRI） includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced （DCE） and diffusion-weighted imaging （DWI）. mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniquesmincluding direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound （MRI-US） fusion--have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed.

Three-dimensional printing technique assisted cognitive fusion in targeted prostate biopsy

Objective:To explore the effect of 3-dimensional(3D)printing-assisted cognitive fusion on improvement of the positive rate in prostate biopsy.Methods:From August to December 2014,16 patients with suspected prostatic lesions detected by multiparametric magnetic resonance imaging(MRI)were included.Targeted prostate biopsy was performed with the use of prostate 3D reconstruction modeling,computersimulated biopsy,3D printing,and cognitive fusion biopsy.All patients had received 3.0 T multiparametric MRI before biopsy.The DICOM MRI files were imported to medical imaging processing software for 3D reconstruction modeling to generate a printable.stl file for 3D printing with use of transparent resin as raw material.We further performed a targeted 2-to 3-core biopsy at suspected lesions spotted on MRI.Results:For the 16 patients in the present study,3D modeling with cognitive fusion-based targeted biopsy was successfully performed.For a single patient,1e2 lesions(average:1.1 lesions)were discovered,followed by 2-6 cores(average:2.4 cores)added as targeted biopsy.Systematic biopsies accounted for 192 cores in total,with a positive rate of 22.4%;targeted biopsies accounted for 39 cores in total,with a positive rate of 46.2%.Among these cases,10 patients(62.5%)were diagnosed with prostate adenocarcinoma,in which seven were discovered by both systematic and targeted biopsy,one was diagnosed by systematic biopsy only,and two were diagnosed by targeted biopsy only.For systematic biopsy,Gleason score ranged from 6 to 8(average:7),while that for targeted biopsy ranged from 6 to 9(average:7.67).Among the seven patients that were diagnosed by both systematic and targeted biopsy,three(42.8%)were reported with a higher Gleason score in targeted therapy than in systematic biopsy.Conclusion:3D printing-assisted cognitive fusion technique markedly promoted positive rate in prostate biopsy,and reduced missed detection in high-risk prostate cancer.

Magnetic resonance imaging-guided prostate biopsydA review of literature

Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy.Materials and methods:A literature search was performed for“multiparametric MRI”,“MRI fusion biopsy”,“MRI guided biopsy”,“prostate biopsy”,“MRI cognitive biopsy”,“MRI fusion biopsy systems”,“prostate biopsy”and“cost analysis”.The search operation was performed using the operator“OR”and“AND”with the above key words.All relevant systematic reviews,original articles,case series,and case reports were selected for this review.Results:The sensitivity of MRI targeted biopsy(MRI-TB)is between 91%e93%,and the specificity is between 36%e41%in various studies.It also has a high negative predictive value(NPV)of 89%e92%and a positive predictive value(PPV)of 51%e52%.The yield of MRI fusion biopsy(MRI-FB)is similar,if not superior to MR cognitive biopsy.In-bore MRI-TB had better detection rates compared to MR cognitive biopsy,but were similar to MR fusion biopsy.Conclusions:The use of MRI guidance in prostate biopsy is inevitable,subject to availability,cost,and experience.Any one of the three modalities(i.e.MRI cognitive,MRI fusion and MRI in-bore approach)can be used.MRI-FB has a fine balance with regards to accuracy,practicality and affordability.

The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging （MRI） on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI, A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6days. The accuracy of the MRI for simplified tumor location （right, left, bilateral and none） was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ＇MRI predicted a unilateral lesion, but pathology revealed bilateral lesions＇ （58.3%）, followed by ＇MRI predicted no lesion, but pathology revealed the presence of a lesion＇ （32.0%）. Multivariable analysis showed that the discordant group had a shorter interval （25.0 ± 14.3 vs 38.1 ± 20.6days, P 〈 0.01） preceding the MRI and a higher rate of hemorrhage as observed by MRI （80.4% vs 54.8%, P 〈 0.01） in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 （P 〈 0.001）. At the MRI interval＇s cutoff of 28.5days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28days, the accumulated accuracy was only 26.1% （23/88）; however, when it was performed after 28days, the reversely accumulated accuracy was 61.5% （59/96）. These data support a waiting period of at least 4weeks after a biopsy before performing an MRI for the purposes of surgical refinement.

Spondylodiscitis, an Exceptional Complication of Prostate Biopsy: Case Report

Background: Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. Aim: To report a case of spondylodiscitis due to a transrectal prostate biopsy and highlight therapeutical principles. Case Presentation: A 60-year-old male underwent transrectal prostate biopsy performed because of high PSA level, and presented 48 hours later with back pain, fever at 40°C associated with an obnubilation. He was treated for malaria without favorable evolution. Persistance of pain and occurrence of neurologic manifestations motivated dorso-lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which permitted diagnosis of spondylodiscitis. The treatment was made by triple antibiotic therapy combining Imipenem 500 mg/8h (IV);Ofloxacin 200 mg/12h (IV) and Metronidazole 500 mg/8h (IV) over four weeks. Evolution under treatment was favorable. Conclusion: Spondylodiscitis is an exceptional complication of transrectal prostate biopsy. It may be evocated in case of bones pain after prostate biopsy.

Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy？ A prospective, randomized trial

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G-needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group （94 patients, Group A） received a transperineal prostate biopsy using a 16 G-needle and the second group （93 patients, Group B） underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale （VAS） and facial expression scale （FES） were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen （PSA） and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18- and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible Further studies with larger patient populations are required to prostate cancer detection rates. procedure in terms of pain and complication rates. assess whether or not this procedure can improve

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy

This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.

Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia:Experience from a single institution in Malaysia

Background Freehand transperineal prostate biopsy(TPPBx)using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer(PCa).It only requires the same equipment used for transrectal ultrasound-guided(TRUS)biopsy.Our study is the first in Malaysia to report this experience and its outcomes.We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia(LA).Methods Institutional review board approval was obtained from National Medical Research Register(NMRR ID-21-02052-VIL).We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022.Records were reviewed for patients’characteristics,prostate volume,prostate-specific antigen(PSA)results,biopsy results and pain tolerability.Data was analyzed to determine PCa and clinically significant prostate cancer(csPCa)detection rate.LA was achieved using perineal skin infiltration and a periprostatic nerve block.The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide.The principles of the Ginsburg protocol were followed.Pain tolerability was assessed using a visual analog scale.Results A total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA.The mean age was 67.3 years,the median PSA was 14.2 ng/mL,and the median PSA density(PSAD)was 0.33 ng/mL/cc.The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc(area under the curve[AUC],0.792;sensitivity,87.5%;specificity,69.2%).PCa was detected in 24 patients(43.6%),of whom 16(29.1%)had csPCa.The median pain scores during LA infiltration and biopsy were four and two,respectively,which were significant different(P<0.05).TPPBx exhibited an infection rate of zero.Conclusion The PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series.The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.

The role of the serum testosterone levels as a predictor of prostate cancer in patients with atypical small acinar proliferation at the first prostate biopsy

The current literature does not support the usefulness of clinical markers on predicting which patients with atypical small acinar proliferation （ASAP） are more likely to progress to prostate cancer （PCa）. Androgens have long been considered to be the potential risk factors for PCa. However, the role of testosterone is controversial. The present study aims to analyze the relationship between serum testosterone （TS） levels and the diagnosis of PCa after a first prostate biopsy in patients affected by ASAP. This retrospective study included 143 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa according to the European Association of Urology guidelines. Their TS levels, age, PSA, prostate volume, digital rectal examination, and prostate biopsy Gleason score （GS） were collected retrospectively for statistical analysis. All patients included in the study had a second biopsy and were suitable for further analysis. Re-biopsy was carried out 3-6 months after the first diagnosis of ASAP. Low and normal TS groups were composed of 29 （20.3%） and 114 （79.7%） patients, respectively. The diagnosis of the second biopsy was ASAP in 25.2% and PCa in 36.4% of patients. The comparison between patients with PCa and those with negative or an ASAP result in the second biopsy reported that men with cancer had significantly higher levels of TS （P 〈 0.001）. However, there was no statistically significant association between GS postbiopsy and TS （P = 0.324）. Our experience demonstrated that eugonadal patients may be a clinical risk factor for the diagnosis of PCa on re-biopsy after ASAP diagnosis than hypogonadal.

Association of the neutrophil-to-lymphocyte ratio and prostate cancer detection rates in patients via contemporary multi-core prostate biopsy

The aim of this study was to determine whether the neutrophil-to-lymphocyte ratio （NLR）, a measure of the systemic inflammatory response is associated with the overall prostate cancer detection rate in men who underwent contemporary multi （〉12）-core transrectal ultrasound （TRUS） biopsy. We reviewed the records of 3913 patients with initial prostate-specific antigen （PSA） levels ranging from 4 to 10 ng ml^-1 who underwent TRUS-guided prostate biopsy between April 2006 and May 2014. NLR was calculated by prebiopsy neutrophil and lymphocyte counts. We excluded patients who had evidence of acute prostatitis, a history of prostate surgery, and any systemic inflammatory disease. A multivariate logistic regression model was used to analyze prostate cancer detection. After adjusting for confounding factors, predictive values were determined according to the receiver operating characteristic-derived area under the curve, both including and excluding the NLR variable. In univariate analyses, NLR was a significant predictor of prostate cancer detection （P 〈 0.001）. In multivariate analyses, a higher NLR was significantly associated with prostate cancer detection after adjusting for other factors （OR = 1.372, P = 0.038）. The addition of NLR increased the accuracy from 0.712 to 0,725 （P = 0.005） in the multivariate model for prostate cancer detection. NLR may be a potentially useful clinical marker in the detection of prostate cancer among men with a PSA level in the 4-10 ng ml^-1 range. These findings are derived from a retrospective analysis and should be validated in larger populations through prospective studies.

Cognitive magnetic resonance imaging-ultrasound fusion transperineal targeted biopsy combined with randomized biopsy in detection of prostate cancer

BACKGROUND Prostate cancer(PCa)is one of the most common cancers among men.Various strategies for targeted biopsy based on multiparametric magnetic resonance imaging(mp-MRI)have emerged,which may improve the accuracy of detecting clinically significant PCa in recent years.AIM To investigate the diagnostic efficiency of a template for cognitive MRIultrasound fusion transperineal targeted plus randomized biopsy in detecting PCa.METHODS Data from patients with an increasing prostate-specific antigen(PSA)level but less than 20 ng/mL and at least one lesion suspicious for PCa on MRI from December 2015 to June 2018 were retrospectively analyzed.All patients underwent cognitive fusion transperineal template-guided targeted biopsy followed by randomized biopsy outside the targeted area.A total of 127 patients with complete data were included in the final analysis.A multivariable logistic regression analysis was conducted,and a two-sided P<0.05 was considered statistically significant.RESULTS PCa was detected in 66 of 127 patients,and 56 cases presented clinically significant PCa.Cognitive fusion targeted biopsy alone detected 59/127 cases of PCa,specifically 52/59 cases with clinically significant PCa and 7/59 cases with clinically insignificant PCa.A randomized biopsy detected seven cases of PCa negative on targeted biopsy,and four cases had clinically significant PCa.PSA density(OR:1.008,95%CI:1.003-1.012,P=0.001;OR:1.006,95%CI:1.002-1.010,P=0.004)and Prostate Imaging-Reporting and Data System(PI-RADS)scores(both P<0.001)were independently associated with the results of cognitive fusion targeted biopsy combined with randomized biopsy and targeted biopsy alone.CONCLUSION This single-centered study proposed a feasible template for cognitive MRIultrasound fusion transperineal targeted plus randomized biopsy.Patients with higher PSAD and PI-RADS scores were more likely to be diagnosed with PCa.

Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance

Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate
6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.

Prostate chronic inflammation type Ⅳ and prostate cancer risk in patients undergoing first biopsy set:Results of a large cohort study

Objective:In prostate specimens,chronic inflammatory infiltrate(CII)type Ⅳ has been detected,but its association with prostate cancer(PCa)is controversial.The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set.Methods:Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients.The study excluded patients who were in active surveillance,prostate specific antigen(PSA)
30 ng/mL,re-biopsies,incidental PCa after transurethral resection of the prostate(TURP),less than 14 cores or metastatic.Analysis of population and subpopulations(with or without PCa)was performed by statistical methods which included ManneWhitney(U test),KruskaleWallis test,Chi-squared statistic,logistic regression.Multivariate logistic regression models predicting mean probability of PCa detection were established.Results:PCa detection rate was 46.03%.Age,PSA,prostate volume(PV),prostate intraepithelial neoplasia(PIN)and CII were the significant independent predictors of PCa detection.PV(OR Z 0.934)and CII(OR Z 0.192)were both negative independent predictors.CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age,PSA and PV.The inverse association of CII with PCa does not necessary mean protection because of PSA confounding.Conclusion:In a population of patients undergoing prostate first biopsy set,CII was a strong negative independent predictor of PCa detection.CII type Ⅳ should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.

Development and validation of a nomogram including lymphocyte-to-monocyte ratio for initial prostate biopsy:a double-center retrospective study

Here,we developed a prostate cancer(PCa)risk nomogram including lymphocyte-to-monocyte ratio(LMR)for initial prostate biopsy,and internal and external validation were further conducted.A prediction model was developed on a training set.Significant risk factors with P<0.10 in multivariate logistic regression models were used to generate a nomogram.Discrimination,calibration,and clinical usefulness of the model were assessed using C-index,calibration plot,and decision curve analysis(DCA).The nomogram was re-examined with the internal and external validation set.A nomogram predicting PCa risk in patients with prostate-specific antigen(PSA)4-10 ng ml^(-1)was also developed.The model displayed good discrimination with C-index of 0.830(95%confidence interval[Cl]:0.812-0.852).High C-index of 0.864(95%Cl:0.840-0.888)and 0.871(95%Cl:0.861-0.881)was still reached in the internal and external validation sets,respectively.The nomogram exhibited better performance compared to the nomogram with PSA only(C-index:0.763,95%Cl:0.746-0.780,P<0.001)and the nomogram with LMR excluded(C-index:0.824,95%Cl:0.804-0.844,P<0.010).The calibration curve demonstrated good agreement in the internal and external validation sets.DCA showed that the nomogram was useful at the threshold probability of>4%and<99%.The nomogram predicting PCa risk in patients with PSA 4-10 ng ml^(-1)also displayed good calibration and discrimination performance(C-index:0.734,95%Cl:0.708-0.760).This nomogram incorporating age,PSA,digital rectal examination,abnormal imaging signals,PSA density,and LMR could be used to facilitate individual PCa risk prediction in initial prostate biopsy.

Prostate magnetic resonance imaging and the value of experience:An intrareader variability study

Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced genitourinary radiologist re-reported his original 100 consecutive mpMRIp scans using Prostate Imaging-Reporting and Data System version 2(PI-RADS v2)after 5 years of further experience comprising>1000 scans.Intraobserver agreement was measured using Cohen's kappa.Sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV),and accuracy were calculated,and comparison of sensitivity was performed using McNemar's test.Results Ninety-six mpMRIp scans were included in our final analysis.Of the 96 patients,53(55.2%)patients underwent subsequent biopsy(n=43)or prostatectomy(n=15),with 73 lesions targeted.Moderate agreement(Cohen's kappa 0.55)was seen in the number of lesions identified at initial reporting and on re-reading(81 vs.39 total lesions;and 71 vs.37 number of PI-RADS≥3 lesions).For clinically significant prostate cancer,re-reading demonstrated an increase in specificity(from 43%to 89%)and PPV(from 62%to 87%),but a decrease in sensitivity(from 94%to 72%,p=0.01)and NPV(from 89%to 77%).Conclusion The intraobserver agreement for a novice to experienced radiologist reporting mpMRIp using PI-RADS v2 is moderate.Reduced sensitivity is off-set by improved specificity and PPV,which validate mpMRIp as a gold standard for prebiopsy screening.

Randomized controlled trial of antibiotic prophylaxis regimens for transrectal ultrasound-guided prostate biopsy

Background A prior study showed aimed to evaluate and compare the transrectal ultrasound-guided prostate Methods A prospective randomized significant antibiotic resistance to quinolone in our population. In this study we efficacy of a single versus a combined prophylactic antibiotic regimen before biopsy （TRUGPB）. study was conducted at a university hospital. Patients undergoing TRUGPB were randomized into an amoxicillin-clavulanate alone （1 mg; one dose before and two doses after biopsy） or an amoxicillin-clavulanate ＋ ciprofloxacin group （250 mg; one dose before and two doses after biopsy）. Patients were surveyed for infection symptoms by phone on days 3 and 30 after TRUGPB. We defined an infective complication as the occurrence of symptoms including fever, chills or rigor within 30 days after prostate biopsy, requiring medical treatment or hospitalization, aided by a territory-wide electronic medical record system. Results Between November 2007 and July 2009, 367 patients were randomized to either amoxicillin-clavulanate alone or amoxicillin-clavulanate ＋ ciprofloxacin group. The infection rates after TRUGPB were 3.91% in the former group （7 out of 179 patients） versus 0.53% （1 out of 188 patients） in the latter. Sixty-three percent （5/8） of patients with infective complications needed hospitalization. There was no intensive care unit admission or mortality during the study period. Conclusions Combining prophylactic antibiotics with amoxicillin-clavulanate ＋ ciprofloxacin significantly reduced the incidence of infective complications after TRUGPB. We recommended a combination regimen, especially in centre with high incidence of post-TRUGPB infection.

EFFECT OF 1% TETRACAINE HYDROCHLORIDE JELLY FOR PAIN CONTROL DURING TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY

Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each. In Group 1, patients received liquid paraffin, and in Group 2, patients were given 1% tetracaine hydrochloride jelly before biopsy. Pain score was measured by horizontal visual analogue scales （ VAS ）, and pain and discomfort were compared between the two groups. Results The average pain scores at the time of insertion of the ultrasound probe were 2. 9 ＋_1. 7 and 1. 4 ＋_1. 8 （ P =0. 000） and the average pain scores at the time of performing biopsy were 5. 2 ＋-1. 5 and 3. 1 ＋ 1. 7 （P =0. 000） in Group 1 and Group 2, respectively. There were no significant differences between the two groups in terms of age, serum prostate specific antigen, digital rectal examination, TRUS, and biopsy core number （ P 〉 O. 05 ）. There were no significant differences of complications after biopsy, such as hematuria, acute urinary retention, urinary tract infection, rectum bleeding, and fever （ P 〉0. 05）. Conclusion TRUS-guided prostate biopsy is safe. Use of 1% tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS-guided prostate biopsy-induced pain during the procedure.

A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen （PSA）, prostate volume （PV）, digital rectal examination （DRE） status, % free PSA and transrectal ultrasound （TRUS） findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% （223/535）. The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.