Perineal Mapping Biopsy of Prostate: Experience from a Single Academic Institution and Impact on Prostate Cancer Management.
Lakshmi P Kunju, Rabia Siddiqui, Michael Rowley, David Miller, Stepahnie Meyers, Dave Wood, John T Wei. University of Michigan, Ann Arbor
Background: Appropriate patient selection for active surveillance is crucial. We evaluated the utility and morbidity of perineal prostate mapping biopsy prior to making a decision for definitive therapy of prostate cancer (PCa).
Design: 116 patients with elevated/rising PSA and/or previous diagnosis of PCa with at least 1 prior transrectal prostate biopsy underwent restaging with perineal template mapping prostate biopsy at a single academic institution between Sept 2007 and June 2010. Seventy five (64%)patients had a previous PCa diagnosis while 41 (36%)patients had no previous history of PCa. All biopsies were performed by two experienced urologists using transrectal ultrasound and brachytherapy implant grid under spinal or general anesthesia. Samples were taken every 5 mm throughout the volume of the prostate and labeled separately.
Results: The mean age was 62.5Y (SD ±9). The mean number of cores obtained was 61 (SD ±14) and mean number of positive cores was 4.9 (SD±5). PCa was identified in 81/116 (70%) patients, including 59 (51%) patients with a previous PCa diagnosis vs. 22 (19%) with no history of PCa. Significant PCa (Gleason Score ≥7) was noted in 42 /116 (36%) patients including 27 (23%) and 15 (13%) of patients with and without history of PCa respectively. Seven of 116 (6%) patients had high-grade PCa (Gleason score ≥8), of which 5 (4%) were diagnosed in patients with no previous history of PCa. Complications were limited and included 18 patients (8%) with urinary retention (10) or hematuria (8). Twenty eight patients (24%) underwent definitive therapy for PCa including robotic radical prostatectomy (19%), radiation therapy (4%) and cryosurgery (1%). Eighty-four (72%) patients are on active surveillance.
Conclusions: Perineal mapping biopsy of the prostate is well tolerated and can be safely used to provide accurate staging information for PCa management. It is potentially a very useful tool in selecting patients for active surveillance and can profoundly impact personalized management of PCa.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 75, Wednesday Morning