Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Prostate Biopsy: A Systematic Review and Meta-analysis of Prospective Studies.

Autor: Zattoni F; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy; Department of Medicine - DIMED, University of Padua, Padua, Italy. Electronic address: fabio.zattoni@unipd.it., Rajwa P; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland., Miszczyk M; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland., Fazekas T; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Semmelweis University, Budapest, Hungary., Carletti F; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Carrozza S; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Sattin F; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Reitano G; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Botti S; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Matsukawa A; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Dal Moro F; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Jeffrey Karnes R; Department of Urology, Mayo Clinic, Rochester, MN, USA., Briganti A; Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Novara G; Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Shariat SF; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Semmelweis University, Budapest, Hungary; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Research Center for Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz, Iran., Ploussard G; La Croix du Sud Hospital, Quint-Fonsegrives, France., Gandaglia G; Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Jazyk: angličtina
Zdroj: European urology oncology [Eur Urol Oncol] 2024 Dec; Vol. 7 (6), pp. 1303-1312. Date of Electronic Publication: 2024 Aug 01.
DOI: 10.1016/j.euo.2024.07.009
Abstrakt: Background and Objective: The benefits of the detection of clinically significant prostate cancer (csPCa) and safety of magnetic resonance imaging (MRI)-targeted transperineal (TP) prostate biopsy (TP-Tbx) versus transrectal (TR) approaches are still a matter of debate. This review aims to compare the efficacy and safety of TP-Tbx and MRI-targeted TR biopsy (TR-Tbx).
Methods: A systematic literature search was performed in PubMed/Medline, Scopus, and Web of Science to identify records of prospective randomized controlled trials (RCTs) comparing TP-Tbx and TR-Tbx published until May 2024. The primary outcomes included detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥2) and rates of complications.
Key Findings and Limitations: Three RCTs (PREVENT, ProBE-PC, and PERFECT) met the inclusion criteria. The TR technique was commonly administered with antibiotic prophylaxis to mitigate infection risks or after a rectal swab. No difference was found between TP-Tbx and TR-Tbx in terms of either csPCa (odds ratio [OR] 0.9, 95% confidence interval [CI]: 0.7-1.1) or ISUP 1 prostate cancer (PCa; OR 1.1, 95% CI: 0.8-1.4) detection. Postprocedural infection (OR 0.8, 95% CI: 0.4-1.8), sepsis (OR 0.6, 95% CI: 0.1-4.5), and urinary retention rates (OR 0.5, 95% CI: 0.1-1.6) were similar. Pain during the TP approach was slightly higher than during the TR approach, but after 7 d of follow-up, the differences between the two approaches were minimal. Variations in biopsy numbers per patient, patient selection, use of 5-alpha reductase inhibitors, needle sizes, TP techniques, and pain scores (reported in only one RCT), along with the multicenter nature of RCTs, limit the study.
Conclusions and Clinical Implications: TP-Tbx and TR-Tbx show similar results in detecting PCa, with comparable rates of infections, urinary retention, and effectiveness in managing biopsy-associated pain. TP-Tbx can safely omit antibiotics without increasing infection risk, unlike TR-Tbx. The tendency to exclude from practice TR-Tbx with prophylactic antibiotics due to infection concerns could be moderated; however, the directionality of some key outcomes, as infections and sepsis, favor the TP approach despite a lack of statistical significance.
Patient Summary: There were no significant differences in the prostate biopsy approaches (transperineal [TP] vs transrectal [TR]) for prostate cancer detection and complications. However, the MRI-targeted TP prostate biopsy approach may be advantageous as it can be performed safely without antibiotics, potentially reducing antibiotic resistance.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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