RESUMEN
PURPOSE: To compare transperineal (TP) vs transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion-guided prostate biopsy (PBx) in a large, ethnically diverse and multiracial cohort. MATERIALS AND METHODS: Consecutive patients who underwent multiparametric (mp) MRI followed by TP or TR TRUS-fusion guided PBx, were identified from a prospective database (IRB #HS-13-00663). All patients underwent mpMRI followed by 12-14 core systematic PBx. A minimum of two additional target-biopsy cores were taken per PIRADS≥3 lesion. The endpoint was the detection of clinically significant prostate cancer (CSPCa; Grade Group, GG≥2). Statistical significance was defined as p<0.05. RESULTS: A total of 1491 patients met inclusion criteria, with 480 undergoing TP and 1011 TR PBx. Overall, 11% of patients were Asians, 5% African Americans, 14% Hispanic, 14% Others, and 56% White, similar between TP and TR (p=0.4). For PIRADS 3-5, the TP PBx CSPCa detection was significantly higher (61% vs 54%, p=0.03) than TR PBx, but not for PIRADS 1-2 (13% vs 13%, p=1.0). After adjusting for confounders on multivariable analysis, Black race, but not the PBx approach (TP vs TR), was an independent predictor of CSPCa detection. The median maximum cancer core length (11 vs 8mm; p<0.001) and percent (80% vs 60%; p<0.001) were greater for TP PBx even after adjusting for confounders. CONCLUSIONS: In a large and diverse cohort, Black race, but not the biopsy approach, was an independent predictor for CSPCa detection. TP and TR PBx yielded similar CSPCa detection rates; however the TP PBx was histologically more informative.
Asunto(s)
Biopsia Guiada por Imagen , Próstata , Neoplasias de la Próstata , Ultrasonografía Intervencional , Humanos , Masculino , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Biopsia Guiada por Imagen/métodos , Persona de Mediana Edad , Anciano , Ultrasonografía Intervencional/métodos , Próstata/patología , Próstata/diagnóstico por imagen , Perineo , Imagen por Resonancia Magnética Intervencional/métodos , Clasificación del Tumor , Imágenes de Resonancia Magnética Multiparamétrica/métodos , Reproducibilidad de los ResultadosRESUMEN
ABSTRACT: Issues related to the distribution and availability of supplies and personnel in nuclear medicine are well known and episodic. The combination of COVID-related restrictions and the unprecedented growth of our specialty have acutely exacerbated these supply and demand mismatches.
