OBJECTIVE: MRI-Ultrasound fusion guided targeted biopsy has revolutionized the diagnosis of prostatecancer through accurate identification, localization and characterization of prostatic lesions utilizingthe prostate imaging reporting and data system (PI-RADS) scoring system by multiparametric MRI(MPMRI). The fusion prostate biopsy system on the other hand, enables accurate targeting and easyaccess of the tumor. The study objective is to determine the detection rate of clinically-significantprostate cancer using fusion biopsy, and to establish the correlation between PI-RADS score andGleason's score. PATIENTS AND METHODS: A retrospective cohort study was conducted to determine the correlation betweenPI-RADS score and the presence of prostate cancer using MRI-Ultrasound fusion guided transperinealprostate biopsy. This was carried out from June 2017 to July 2018 in a single institution. One hundredthirty five (135) men were included in this study. They presented with an elevated PSA, abnormalDRE or a previous negative prostate biopsy, but with a persistent rise in PSA. A total of 220 prostatelesions were identified. The following characteristics were measured: patient age; the size, location,the PI-RADS score of each lesion, the maximum PI-RADS score for select patients; and the Gleasonscore of discovered tumors. RESULTS: Two hundred twenty PI-RADS 3, 4 and 5 lesions were detected in 135 patients by MPMRI.131 of the 220 lesions were scored as PI-RADS 3, 61 as PI-RADS 4 and 28 as PI-RADS 5. Theselesions were biopsied using the MRI-Ultrasound fusion guided transperineal prostate biopsy system.Thirty-three out of the 131 PI-RADS 3 lesions (25.2%), 44 out of the 61 PI-RADS 4 lesions (72.1%)and 24 out of the 28 PI-RADS 5 lesions (85.7%) respectively were positive for malignancy. Overall,there were 101 (45.9%) lesions classified as PI-RADS 3 to 5 that were positive for prostate carcinoma.Seventy four (74) of the 135 patients (54.8%) were diagnosed with prostate adenocarcinoma. Nineteenout of 65 patients with a maximum score of PI-RADS 3 (29.2%), 33 of 44 with a maximum of PI-RADS 4 (75%) and 22 of 26 with a maximum of PI-RADS 5 (84.6%) harbored malignancy. In termsof location, 45 of the 101 (44.6%) malignancies were in the peripheral sector, 31 (30.7%) in theanterior sector, and 25 (24.8%) in the central sector of the prostate. The mean Gleason grade of PI-RADS 3, 4 and 5 lesions were 6.61, 7.73, and 7.38, respectively. Using Spearman correlation, the rhocoefficient was 0.3153 (p-value =.00013) which denotes a significant positive relationship betweenGleason and PI-RADS score. CONCLUSION This is the first comprehensive Philippine study on Multiparametric MRI-Ultrasoundfusion-guided transperineal prostate biopsy. Present data validate the superiority of MPMRI in theidentification, localization and characterization of prostate cancers. The authors also verified thepositive correlation between PI-RADS score and Gleason score. Finally, they demonstrated theaccuracy of the MRI- ultrasound fusion-guided transperineal prostate biopsy system in targetingprostate lesions.

OBJECTIVES

To describe the demographics of patients undergoing supine PCNL (s-PCNL) and prone PCNL (p-PCNL) at Veterans Memorial Medical Center (VMMC) and to compare different data collected between the two approaches.

METHODS

Retrospective data collection was done through chart review of patients who underwent supine and prone PCNL at VMMC from 2018 to 2022. Information collected includes patient demographics, clinical profile, stone burden and laterality, surgical technique, hospital days, complications and management.

RESULTS

A total of 176 cases, 132 s-PCNL and 44 p-PCNL, were included. Demographic data show no statistical difference as to age and sex. There is no statistical difference in the stone burden, stone density, and Guy’s stone scores between the two groups. There was no statistical difference in the mean operative time and stone free rates between the two groups. Mean hospital stay was 6.11 days for s-PCNL and 6.76 for p-PCNL, with significant statistical difference in favor of s-PCNL. Complication rates were 15.2% for supine PCNL and 13.6% for prone PCNL. There was no statistical significant difference in Clavien-Dindo complications between the two groups. There was no mortality reported for both groups.

CONCLUSION

There is an observed increasing trend in the number of supine PCNL versus prone PCNL from 2018 to 2022. Supine PCNL is as effective and safe as prone PCNL. Supine PCNL appears to be more beneficial in terms of hospital stay in days. However, one limitation of the study its being retrospective and collated data which is the cause of the discrepancy in sample population size between the two groups.

Human ; Renal Calculi ; Kidney Calculi

INTRODUCTION

Prostate cancer, a significant male health concern (ASR: 29.3/100,000), demands accurate diagnosis. Prostate biopsy, pivotal for clinical decisions, relies on transrectal biopsy as the norm, despite limitations like infection risk and incomplete sampling. An alternative, transperineal biopsy, grants broader access but demands more time and anesthesia. Escalating complications due to antibiotic resistance heighten apprehensions. Discrepancies in complications emerge from varied studies, while cancer detection rates stay consistent (45-49%). These conflicting outcomes raise vital safety issues. This study strives to bridge the information void by assessing complications within the local context, offering clarity for informed biopsy choices. With 150 words, the importance of evaluating biopsy methods in light of complications becomes evident, emphasizing the significance of this research in guiding clinical practice.

OBJECTIVE

This research aims to compare ultrasound guided transrectal prostate biopsy and freehand ultrasound guided transperineal biopsy at a Quezon City government hospital. Specific objectives include describing patient profiles for each technique, assessing infection rates, evaluating pain tolerance, comparing hematuria levels, measuring dysuria immediately post-biopsy and 1 day after, analyzing hospitalization rates, evaluating the techniques’ effectiveness in detecting prostate cancer, and reviewing histopathologic differences in prostatitis between the two methods.

METHODS

The study was conducted at the Veterans Memorial Medical Center Urology Section from January to October 2023. Using a prospective, descriptive, cross-sectional design, male patients undergoing ultrasound guided transrectal or transperineal prostate biopsies were included. Inclusion criteria include males aged 45 and above with PSA above 4.0 ng/dl and abnormal prostate findings. Exclusion criteria cover repeat biopsy cases and prior prostate cancer diagnosis. With an assumed 50% detection and complication rate, a minimum of 109 patients for each biopsy type was required for a 95% confidence level and 5% margin of error, totaling 218 participants.

RESULTS

The study compared transrectal and transperineal prostate biopsies in terms of patient characteristics, complications, diagnostic accuracy, and cancer detection rates. Patients undergoing transrectal biopsy had higher mean PSA levels (53.41 vs. 28.59, p=0.024) and received more fosfomycin prophylactic antibiotics (27% vs. 18%, p=0.044) compared to transperineal biopsy patients. Complication rates varied significantly between the two techniques, with chronic prostatitis seen in 5% of transperineal cases (p < 0.01). Transrectal biopsy patients experienced more pain, gross hematuria, urinary retention, fever, and hospitalization (p < 0.01). Diagnostic performance, assessed through the ROC curve’s area under the curve, showed comparable sensitivity and specificity for transrectal (AUC=0.559) and transperineal (AUC=0.441) biopsies (p=0.108). Cancer detection rates did not significantly differ between transrectal (34.4%) and transperineal (45.9%) biopsies (p=0.114). These results provide insights into the differences and similarities between the two biopsy techniques, impacting patient demographics, complications, and diagnostic outcomes.

CONCLUSION

This comparative investigation of transrectal and transperineal prostate biopsies in a tertiary hospital setting yields impactful insights. Participant ages were similar, but transrectal patients had higher PSA levels. Complication rates varied, with more chronic prostatitis in the transperineal group. Transperineal biopsies reduced pain, while transrectal group faced more complications. Cancer detection rates remained comparable. Transperineal biopsies demonstrated advantages in alleviating discomfort and potentially reducing complications. Tailoring biopsy approach based on patient profiles is crucial for diagnostic efficacy and patient well-being. These findings guide informed decision-making, prioritizing safety and experience in prostate biopsy practices.

Human ; Complications