MP33-17: Transperineal Fusion Biopsies with Software Registration: Cancer Detection by piRADS V2

Eusebio Luna*, Gloria Egui-Benatuil, Alberto Lopez-Prieto, Edward Gheiler, Kaufman Ariel, Miami, FL, Farshad Shafizadeh, New York, NY, Luis Avila, Barrios Dailianys, Miami, FL, Juan Martinez-Salamanca, Madrid, Spain, Fernando Bianco, Miami, FL

Introduction: Recently, the European Urological Association guidelines on  prostate biopsies made Transperineal Biopsies (TPBx) their standard of care and advised against transrectal biopsies due to harms such as UTI and urosepsis. We stopped performing TRBx in 2017. Herein we present our experience with TPBx, using fusion registration (MR/US) with a medical device. We aimed to determine the accuracy of piRADS V2 system in this setting.

Methods: For this study, we evaluated Fusion TPBx conducted from October 2017 and May 2021 conducted across 4 centers. Antibiotic prophylaxis was dependent  on the surgeon. Indications for TPBx: elevated PSA, abnormal DRE, Prostate Cancer history. Patients had a multiparametric MRI within 3 months of their TPBx. The MRI was classified using piRADS system and lesions were contoured. Post biopsies follow up consisted of a results visitation and a 30-day phone call that inquired for averse events (AE). The path from the procedure and 30-day outcomes was prospectively collected into the FocalyxApp (IOS & Android) . Correlations between TPBx results, piRADS, presence of prostatitis and prophylactic antibiotics were performed using chi-squares and Bayesan statistics.

Results: 1,317 Fusion TPBx were performed, 1,189  (90%), were conducted under local anesthesia in the office. Prophylactic antibiotics were NOT used in 579 (44%). No episodes of UTI or sepsis were detected.  Median Age, BMI, PSA, MR volume, total cores, target cores, pain reported and Fusion TPBx time was 68.6 years, 27.6 kg/m2, 5.7 ng/ml, 53cc, 16, 7, 3/10 and 19min, respectively. Cancer was found in 617 (47%). The piRADS V2 detection rate for scores 2,3,4 and 5 were 11/35 (15%), 201/661(30%), 241/382(63%) and 162/199 (81%), respectively.  Overall, 572 patients had histological evidence of prostatitis, 276/579 (44%) of the NO prophylaxis group and 316/738 (43%) of the prophylaxis group, p=0.6.  There was no statistical association between histological prostatitis and piRADS, p=0.4. At 30 days, 48 patients experienced an AE, none experience any bacterial proven infection. The most common being urinary retention which occurred in 31 patients and correlated with MR Prostate Volume (Spearman, p=0.001). There were no correlations between AE and antibiotic use or piRADS in MRI.

Conclusions: Our study performed using software fusion registration illustrates the value of the piRADS system. Furthermore, it questions the necessity of antibiotic prophylaxis for TPBx and shows the high prevalence of histological prostatitis neither correlated to piRADS or prophylaxis.

Source of Funding: Urological Research Network Foundation