Transrectal versus transperineal prostate fusion biopsy: a pair-matched analysis to evaluate accuracy and complications

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2024年9月25日

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Marco Oderda,
Romain Diamand,
Rawad Abou Zahr,
Julien Anract,
Gregoire Assenmacher,
Nicolas Barry Delongchamps,
Alexandre Patrick Bui,
Daniel Benamran,
Giorgio Calleris,
Charles Dariane,
Mariaconsiglia Ferriero,
Gaelle Fiard,
Fayek Taha,
Alexandre Fourcade,
Georges Fournier,
Karsten Guenzel,
Adam Halinski,
Giancarlo Marra,
Guillaume Ploussard,
Katerina Rysankova,
Jean-Baptiste Roche,
Giuseppe Simone,
Olivier Windisch,
Paolo Gontero

摘要

Purpose

To evaluate biopsy-related complications and detection rates of any PCa and clinically significant PCa (csPCa, intended as grade group ≥ 2) between MRI-targeted TP fusion biopsies (TPBx) and TR ones (TRBx).

Methods

We performed a multicentric study on 4841 patients who underwent fusion biopsy between 2016 and 2023. A case–control matching was performed to find comparable cohorts of 646 TPBx and 646 TRBx. Mean T test and Pearson chi-square tests were used to compare continuous and categorical variables.

Results

Baseline characteristics were comparable between the cohorts, except for target location with a higher rate of anterior lesions in TPBx group. Complications were rare and no difference was found between the groups, with similar rates of infections after TRBx and TPBx (N = 5 (0.8%) vs N = 2 (0.3%), p 0.45). All patients in TRBx and 90.1% in TPBx group received antibiotic prophylaxis. A higher csPCa detection rate was found in TPBx over the group (50.5% vs 36.2%, p < 0.001). On average, positive targeted cores were increased in TPBx group, for any PCa (1.6 vs 1.4, p 0.04) and csPCa (1.0 vs 0.8, p 0.02). Among the limitations of study, we acknowledge the retrospective design and the possible under-reporting of complications.

Conclusions

MRI-targeted fusion TPBx achieves a significantly higher csPCa detection than TRBx, with a diagnostic advantage for apical and anterior lesions. No significant differences were found in terms of complications that were rare in both groups, considering a widespread adoption of antibiotic prophylaxis.