Abstract: PD43-08
Sources of Funding: None

Introduction

The morbidity and mortality associated with TRUS biopsy has been well documented over the past three decades. Acute urinary retention, rectal bleeding, hematuria and hematospermia, uncomplicated urinary tract infection and urosepsis have all been reported at rates between 2-4%. Mortality is rare at less than 0.4%. The purpose of this study is to assess the rates of morbidity with reduced number of cores, targeted to only the tumor suspicious region under MRI-guidance in an outpatient setting.

Methods

From 2009 to 2016, 3000 men received mpMRI of the prostate. Of those men, 700 underwent in-bore, MRI-guided biopsy in an outpatient setting. All MR guided biopsies were performed using a 1.5 Tesla Philips Achieva XR system (Philips Healthcare, Best, The Netherlands) for both mpMRI image acquisition and in-bore MRI-guided biopsy. DynaCAD and DynaLOC (Invivo, Orlando, FL, USA) software were used for image analysis and biopsy planning. A fully-automatic, titanium biopsy gun was inserted using the DynaTRIM positioning hardware (Invivo, Orlando, FL, USA). Two thirds of the patients undergoing mpMRI were recommended to undergo MR guided biopsy. Of those, 700 underwent MR guided in-bore biopsy. One third of the patients did not undergo prostate biopsy as a result of a negative mpMRI, reducing the number of prostate biopsies in this population.

Results

Of the 700 men who underwent MRI-guided biopsy, only 0.8% experienced complications. Targeting the lesion and reducing the number of cores acquired may reduce morbidity associated with random, systematic biopsy. The average number of tumor suspicious regions identified on mpMRI was1.8 and the average number of core biopsies taken with each MRI-GB was 3.5 cores as opposed to the 12-18 cores taken on average with systematic TRUS Bx. The MRI-GB procedure time on average did not exceed 30 min.

Conclusions

In the current cost-containment environment in healthcare, any reduction in hospital admissions is welcomed. Transrectally delivered, outpatient MRI-guided biopsy may be a means to that end. Limiting the number of cores acquired by targeting biopsy only to MR-visible tumor suspicious regions results in a 0.8% complication rate in our experience. The MRI-GB procedure can be performed quickly and safely in an outpatient setting with or without conscious sedation.

Funding

None