Harvard Medical School, Boston, MA.
Harvard Medical School, Boston, MA; Department of Urology, Massachusetts General Hospital, Boston, MA.
Urology. 2021 Sep;155:26-32. doi: 10.1016/j.urology.2021.04.040. Epub 2021 May 25.
To describe our recent experience with in-office transperineal prostate biopsy, including the adoption of software-assisted MRI/US fusion technology. Technological improvements have recently allowed transperineal biopsy to be effectively integrated into outpatient practices with negligible risk of infection.
We retrospectively reviewed a cohort of men undergoing transperineal prostate biopsy from 2018-2020, at a single institution. We compared this to another cohort of men undergoing transrectal fusion biopsy from 2014-2018, matched to the first cohort based on age, PSA, and presence of prostate cancer diagnosis prior to biopsy. All patients underwent systematic transperineal templated biopsies in addition to fusion biopsies of MRI-visible lesions. Baseline characteristics, MRI findings, biopsy results, and complications were analyzed and compared between the 2 groups.
One-hundred and thirty men underwent transperineal prostate biopsy, and 130 men underwent transrectal fusion biopsy. Of those who underwent transperineal biopsy, 30% underwent fusion biopsy while all men with the transrectal biopsy underwent fusion biopsy. Men who underwent transperineal vs transrectal biopsy demonstrated lower infection rates (0% vs 0.8%, P = .31) with fewer prophylactic antibiotics prescribed at provider's discretion (48% vs 100%), yet higher total post-biopsy complication rates (6.1% vs 0.8%, P = .036).
Our initial experiences with transperineal prostate biopsy confirm prior findings demonstrating feasibility in outpatient urologic practice without infectious complication. Software-assisted MRI/US fusion technology can be successfully integrated with transperineal biopsies to target suspicious lesions. Higher rates of non-infectious complications were observed compared with transrectal biopsy. Further analysis is needed to determine whether risk profiles improve over the learning curve of this newly implemented approach.
描述我们最近在门诊经会阴前列腺活检方面的经验，包括采用软件辅助 MRI/US 融合技术。最近技术的改进使得经会阴活检能够有效地整合到门诊实践中，感染风险可忽略不计。
我们回顾性地分析了 2018 年至 2020 年在一家机构接受经会阴前列腺活检的一组男性患者的数据，并将其与 2014 年至 2018 年接受经直肠融合活检的另一组男性患者进行比较，两组患者均基于年龄、PSA 和活检前前列腺癌诊断进行匹配。所有患者均接受系统的经会阴模板活检，以及 MRI 可见病变的融合活检。分析和比较两组患者的基线特征、MRI 发现、活检结果和并发症。
130 名男性接受了经会阴前列腺活检，130 名男性接受了经直肠融合活检。在接受经会阴活检的患者中，30%接受了融合活检，而所有接受经直肠活检的患者均接受了融合活检。与经直肠活检相比，接受经会阴活检的患者感染率更低（0% vs 0.8%，P =.31），预防性抗生素的应用比例也较低（48% vs 100%），但总活检后并发症发生率更高（6.1% vs 0.8%，P =.036）。
我们在经会阴前列腺活检方面的初步经验证实了先前的研究结果，即在没有感染并发症的情况下，经会阴活检在门诊泌尿科实践中是可行的。软件辅助 MRI/US 融合技术可以成功地与经会阴活检相结合，以靶向可疑病变。与经直肠活检相比，非感染性并发症的发生率更高。需要进一步分析，以确定在新实施方法的学习曲线中，风险状况是否会有所改善。
