Search

Background: Multiparametric prostate magnetic resonance imaging (mpMRI)-guided fusion prostate biopsy is an emerging technique in the diagnosis of prostate cancer and provides extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. We aimed to investigate the clinical and anatomical risk factors aggravating the pain experienced by patients undergoing mpMRI-guided fusion prostate biopsy., Methods: The prospective study included 319 patients aged 45-75 years who had a prostate-specific antigen <10 ng/ml and a Prostate Imaging Reporting and Data System ≥3 lesion and underwent combined biopsy (targeted biopsy + 12-core standard prostate biopsy) under local anesthesia (intrarectal lidocaine gel + periprostatic nerve block). Immediately after the biopsy procedure, pain assessment was achieved using Visual Analog Scale (VAS). The relationship between the VAS and 13 clinical parameters was evaluated using ordinal logistic regression analysis., Results: The 319 patients had a mean age of 62.39 ± 6.98 years and a median prostate-specific antigen level of 7.20 (range, 5.20-8.50) ng/ml. The VAS was found to be correlated with 4 of 13 parameters, including (i) a shorter prostate-anus surface distance (cutoff value, 55.5 mm), (ii) a narrower anorectal angle (cutoff value, 106.5°), (iii) a larger total prostate volume (cutoff, 61.6 mm 3 ), and (iv) having no history of prior biopsy (biopsy-naive patients)., Conclusion: Anatomical measurements that can be achieved by using mpMRI images (TPV, PASD and ARA) may be useful in the identification of patients at an increased risk of pain during biopsy and also in taking analgesic precautions in such patients., Competing Interests: All authors declare that there are no conflicts of interest in connection with this article., (© 2020 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.)

Background: The number of cores to be obtained in targeted biopsy (TB) is important. This study aimed to evaluate the TB outcomes in suspicious prostate lesions classified according to the Prostate Imaging Reporting and Data System (PI-RADS) and to determine the ideal number of biopsy cores per lesion., Methods: This retrospective study included patients who underwent multiparametric magnetic resonance imaging-guided fusion prostate biopsy owing to increased serum prostate-specific antigen (PSA) levels and suspicious digital rectal examination outcomes in our institute. Patients with PI-RADS <3 lesions, PSA levels >10 ng/ml, and a prior diagnosis of prostate cancer (PCa) (active surveillance) were excluded from the study. The number of biopsy cores to be obtained from each lesion was determined by the clinician., Results: The study included a total of 418 patients and 684 lesions. Among PI-RADS 3 lesions, clinically significant PCa (sPCa) detection rate was similar in the lesions from which 2 and 3 cores were obtained (9.1% and 10.0%, respectively), whereas it was relatively higher in the lesions from which 4 biopsy cores were obtained (18.5%). Among PI-RADS 4 lesions, sPCa detection rate was similar in the lesions from which 3 and 4 cores were obtained (35.6% and 32.3%, respectively), whereas it was relatively lower in the lesions from which 2 biopsy cores were obtained (17.9%). Among PI-RADS 5 lesions, however, sPCa detection rate was similar in the lesions from which 2, 3, or 4 cores were obtained (47.6%, 46.0%, 48.9%, respectively)., Conclusion: The results indicated that the ideal number of cores to be obtained from each suspicious lesion in TB depends on the characteristics of the lesions. Accordingly, while obtaining 2-3 biopsy cores could be adequate in PI-RADS 4 and 5 lesions, which have a serious risk of cancer, a minimum of 4 biopsy cores should be obtained from PI-RADS 3 lesions to ensure accurate histopathological results.Clinical trial number (ClinicalTrials.gov)NCT03936296., Competing Interests: All authors declare that there is no conflict of interest in connection with this article., (© 2020 Asian Pacific Prostate Society. Published by Elsevier B.V.)