Magnetic resonance imaging /ultrasonography fusion transperineal prostate biopsy for prostate cancer: Initial experience at a Middle Eastern tertiary medical centre

Adnan El-Achkar; Mouhammad Al-Mousawy; Nassib Abou Heidar; Hisham Moukaddem; Hero Hussein; Nadim Mouallem; Albert El-Hajj; Muhammad Bulbul

doi:10.1080/2090598X.2021.1926727

Magnetic resonance imaging /ultrasonography fusion transperineal prostate biopsy for prostate cancer: Initial experience at a Middle Eastern tertiary medical centre

Arab J Urol. 2021 Jul 14;19(4):454-459. doi: 10.1080/2090598X.2021.1926727. eCollection 2021.

Authors

Adnan El-Achkar¹, Mouhammad Al-Mousawy¹, Nassib Abou Heidar¹, Hisham Moukaddem², Hero Hussein², Nadim Mouallem², Albert El-Hajj¹, Muhammad Bulbul¹

Affiliations

¹ American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon.
² American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon.

Abstract

Objective: To report on the outcomes of magnetic resonance imaging (MRI)/ultrasonography (US)-fusion transperineal prostate (TP) biopsy at a tertiary medical centre in the Middle East including detection rate of clinically significant prostate cancer (csPCa), complications, and tolerability of the procedure. Patients and methods: Between May 2019 and June 2020, 98 MRI/US-fusion TP biopsies were performed in the US suite using light sedation. All patients had pre-biopsy 3-T multiparametric MRI. Data on patient characteristics, PCa detection rate and complication rates were collected retrospectively. A Gleason score ≥3 + 4 was defined as csPCa.

Results: There were 98 patients, with a mean (SD) age of 65 (9.1) years, and a median (SD) prostate-specific antigen level prior to biopsy of 7.53 (12.97) ng/mL and prostate volume of 51 (31.1) mL. PCa was detected in 54 (55%) patients, with csPCa detected in 43 (44%). A total of 124 Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 lesions were targeted. Grade Group ≥2 PCa was found in 35.5% of the targeted lesions. Random biopsies detected one csPCa Gleason score 3 + 4 in one patient with a negative target. None of the patients had post-biopsy haematuria or retention. Only one patient developed acute prostatitis requiring in-patient intravenous antibiotics.

Conclusions: MRI/US-fusion TP biopsy has an adequate detection rate of csPCa with minimal complications and low infection rates after biopsy. This is one of the first TP biopsy series in the Middle East paving the way for wider adoption in the region.

Abbreviations: AS: active surveillance; AUR: acute urinary retention; GG: Grade Group; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; TP: transperineal; US: ultrasonography; TRUS: transrectal Ultrasound guided.

Keywords: Prostate biopsy; fusion biopsy; image-guided biopsy; prostatic neoplasms; transperineal biopsy.