May 3D prostate biopsy improve the detection rate of prostate cancer ?

Franco Bertolotto1, Angelo Naselli2, Matteo Raggio1, Francesco Germinale1, Paolo Puppo1
  • 1 Centro Urologico di Eccellenza (San Remo)
  • 2 Istituto Clinico Humanitas Mater Domini (Castellanza)

Objective

Standard prostate biopsy relies on the idea of the prostate conformation in the mind of the surgeon as well as the memory of the path of each puncture. Thus it is possible that final result is a not homogenous mapping of the gland. It is even possible that some cores may be obtained from the same portion of prostate. 3d real time prostate biopsy may theoretically overcomes this main flaw. We tested the procedure in a series of consecutive patients, which were never submitted before to any biopsy, to assess the detection rate of prostate cancer and the complication rate

Methods and results

During 2013, 55 patients were submitted to 3d prostate biopsy of the prostate after having signed a specific informed consent in two centers from two trained surgeons (at least 50 procedures each one before the present series). Biopsy was performed by means of the Koelis urostation which allows for a real time 3d reconstruction of the prostate. The path of the biopsy may be visualized in the 3d map of the prostate before the puncture (virtual biopsy), after the puncture (real biopsy) and registered. Each biopsy is labeled and sent for pathological examination in a dedicated box. Patients underwent antibiotic prophylaxis with prulifloxacin 600 mg starting 2 days before the procedure and for the following 5 days. A cleansing enema the morning of the biopsy was also performed.
A median of 14 biopsies were obtained in each session, with a maximum of 20 in very large glands (> 100 mL). Mean patients age was 67. Digital rectal examination was suspicious in 8 cases. PSA was less than 4 ng/mL in 13 cases (13%), between 4-10 (23%) in 32 cases, 10-20 in 4 (7.2%) and greater than 20 in 6 (10%). Glans volume was less than 60 mL in 47 cases (87%). A total of 38 (69%) patients had prostate cancer. Gleason score sum was 6 in 9 (24%), greater than 6 in 29 (76%9 where no cancer was recorded in 17 (31%). Main complications where acute urinary retention in 2 cases and uro-sepsis in 1.

Discussion

The main advantage of the procedure is to kwon exactly were the biopsy is performed, avoiding repeated biopsy in the same location and limiting the total number of punctures to obtain a complete mapping of the gland. Our detection rate is very in high in respect to systematic (random) prostate biopsy performed with standard ultrasound device [1]. The corresponding number of cores per procedures is relatively low [1] as well as the incidence of complications. Moreover the ability to record the mapping for each procedure may allow to repeat the biopsy in the same locations of the first procedure in cases with an indication to rebiopsy. In conclusion, 3d prostate biopsy in naïve patients reaches an elevated detection rate limiting the number of punctures per procedure and the complication rate

References

1) Moore CM, Robertosn NL, Arsanious N, et al. Image-guided prostate biopsy using magnetic resonance imaging–derived targets: a systematic review. Eur Urol. 2013;63:125–40.

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