Page 48 - CUA 2020_Onco_Prostate

2020 CUA Abstracts

MP-4.3. Table 1. Infectious complications following TRBx Methods: A retrospective chart review was conducted on consecutive
and TPBx requiring outpatient or inpatient management patients who underwent TPBx from October 2016 to September 2019.
Patient tolerability was assessed using the Visual Analog Scale
at North York General Hospital (VAS). Patients reported their level of discomfort from 0 (no pain)
TRBx TPBx to 10 (worst pain imaginable) for various parts of the procedure.
(n=1031) (n=1325) Results: A total of 1939 patients underwent a TPBx under local anesthetic.
Fever 1 (0.1) 0 (0) PCa was diagnosed in 1027 (53.0%) patients who had positive pathology.
Clinically significant PCa (Gleason grade group ≥2) was detected in 633
Epididymitis 1 (0.1) 1 (0.1) (61.6%) patients and 113 (11.0%) had exclusively anterior zone pathology
UTI 20 (1.9) 3 (0.2) findings. Acute urinary retention developed in 40 (2.1%) patients follow-
Bacteremia 7 (0.7) 0 (0) ing TPBx. Nine patients (0.5%) presented with symptoms of a urinary tract
infection (UTI) post-biopsy but only five had positive urine cultures. Only
Urosepsis 12 (1.1) 1 (0.1) one (0.05%) patient was admitted to the hospital post-TPBx due to pre-
Septic Shock 2 (1.9) 0 (0) sumed urosepsis; however, cultures were negative. Patient tolerability was
Death 0 (0) 0 (0) assessed in 584 patients with VAS scores of 2.1 for ultrasound probe inser-
tion, 2.5 for the biopsy itself, 2.9 for periprostatic local infiltration, and
All ICs 43 (4.1) 5 (0.4) 3.1 for local skin infiltration.
ER visit 19 (1.8) 4 (0.3) Conclusions: The TPBx under local anesthetic is a safer alternative to the
Hospitalization 26 (2.5) 1 (0.1) TRUSBx biopsy in the detection of PCa. The TPBx has an acceptable can-
cer detection rate with an added ability to detect anterior zone cancers.
ICU stay 2 (1.9) 0 (0) TPBx has a low risk of infectious complications and is well-tolerated. The
TPBx should be considered in the initial diagnosis of PCa.
References
(UTI), which occurred in 1.9% and 0.2% of patients, respectively. Two 1. Liss MA, Ehdaie B, Loeb S, et al. An update of the American
patients developed septic shock post-TRBx, requiring hospitalization in Urological Association white paper on the prevention and treat-
both and an ICU stay in one. There was only one (0.07%) case of urosepsis ment of the more common complications related to prostate biopsy.
in the TP group compared to 12 (1.2%) cases in the TR group. The total J Urol 2017;198:329-34. https://doi.org/10.1016/j.juro.2017.01.103
cost for managing ICs at our hospital post-TRBx was $76 700 compared 2. Pepdjonovic L, Tan GH, Huang S, et al. Zero hospital admissions for
to $4300 in the TP group. infection after 577 transperineal prostate biopsies using single-dose
Conclusions: The TPBx minimizes the risk of ICs, which commonly cephazolin prophylaxis. World J Urol 2017;35:1199-1203. https://
occur post-TRBx. There is near-zero risk of urosepsis post-TPBx. The TPBx doi.org/10.1007/s00345-016-1985-1
can reduce the financial burden on hospitals managing post-biopsy ICs. 3. Ristau BT, Allaway M, Cendo D, et al. Free-hand transperineal pros-
The TPBx improves patient safety and should be considered as a standard tate biopsy provides acceptable cancer detection and minimizes
diagnostic modality for PCa diagnosis. risk of infection: Evolving experience with a 10-sector template.
References Semin Urol Oncol 2018;36:528-e15. https://doi.org/10.1016/j.
1. Nam RK, Saskin R, Lee Y, et al. Increasing hospital admission rates for uro- urolonc.2018.09.013
logical complications after transrectal ultrasound guided prostate biopsy.
J Urol 2010;18:963-9. https://doi.org/10.1016/j.juro.2009.11.043
2. Liss MA, Ehdaie B, Loeb S, et al. An update of the American MP-4.5
Urological Association white paper on the prevention and treat- Assessing the clinical impact of magnetic resonance imaging-
ment of the more common complications related to prostate biopsy. ultrasound fusion targeted prostate biopsies among patients with
J Urol 2017;198:329-34. https://doi.org/10.1016/j.juro.2017.01.103 previously negative transrectal ultrasound biopsy: A community
3. Huang GL, Kang CH, Lee WC, et al. Comparisons of cancer detec- urology experience
tion rate and complications between transrectal and transperineal Thomas Southall , Charlie Gillis , Michelle Anderson , Jennifer Young ,
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prostate biopsy approaches – a single-center preliminary study. BMC Richard Hewitt , J. Matthew Andrews 3
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Urol 2019;19:1-8. https://doi.org/10.1186/s12894-019-0539-4 1 Faculty of Medicine, Memorial University of Newfoundland, St. John’s,
NL, Canada; Department of Radiology, Health Sciences Centre, St. John’s,
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MP-4.4 NL, Canada; Department of Surgery, Division of Urology, Health Sciences
Experience with 1939 transperineal prostate biopsies under local Centre, St. John’s, NL, Canada
anesthesia: Prostate cancer detection rate, complications, and Introduction: Prostate cancer (PCa) is commonly diagnosed among
1,2
tolerability Canadian men. Occasionally, men will experience a clinical suspicion
of PCa and persistent prostate-specific antigen (PSA) elevation despite
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1,3
Veselina Stefanova , Roger J. Buckley , Rupayan Mukherjee , Abirami a negative transrectal ultrasound (TRUS) biopsy. This so-called elusive
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1
1,2
1
1
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Kirubarajan , Stanley Flax , Nicole Golda , Les Spevack , David Hajek , PSA creates a clinical dilemma for urologists. New technologies, such as
1,4
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Andrew Loblaw , Enoch Lai , Adam Tunis 1,5,6 , Joseph Peltz 1,5,6
1 Urology, North York General Hospital, Toronto, ON, Canada; Medicine, magnetic resonance imaging (MRI)-ultrasound (US) fusion targeted biop-
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University of Toronto, Toronto, ON, Canada; Management and Innovation, sies, are designed to increase detection of clinically significant prostate
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cancer (csPCa). We report our experience with MRI-US fusion biopsies
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University of Toronto, Mississauga , ON, Canada; Radiation Oncology, in patients with an elusive PSA.
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Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Radiology, Methods: We prospectively included 97 patients undergoing MRI-US
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North York General Hospital, Toronto, ON, Canada; Diagnostic Imaging, fusion biopsies at our institution from September 2018 to December 2019.
North York General Hospital, Toronto, ON, Canada All men had clinical suspicion of PCa, prior negative TRUS biopsies,
Acknowledgement: Beverly Ann Persaud, Colleen Andersen, and Tim Dong and persistent PSA elevation. Index lesions on multiparametric MRI were
Introduction: The transrectal prostate biopsy (TRUSBx) has been the stan- reviewed using PIRADS v2 scoring system. Lesions classified as PIRADS
dard modality for prostate cancer (PCa) diagnosis. However, the risk of ≥3 received targeted biopsy. Biopsy-naive patients and those on active
urosepsis following TRUSBx has been estimated to be from 5–7%, with surveillance were excluded. The primary outcome was detection rate of
1
hospital admission rates ranging from 2–4%. Recently, the transperineal csPCa, defined as ISUP grade group ≥2. Descriptive statistics were used
prostate biopsy (TPBx) has been growing in favor due to its low risk of to calculate differences in proportions.
post-biopsy infection. 2,3 We report on our experience and outcomes in Results: Prior to fusion biopsy, patients had a mean of 18.5±8.8 negative
patients undergoing TPBx under local anesthesia.
core biopsies per patient, mean PSA 11.81±6.33 ng/ml. MRI-US fusion
S98 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)