AccScience Publishing / JBM / Online First / DOI: 10.14440/jbm.2025.0115
PROTOCOL

Magnetic resonance imaging/ultrasound fusion-guided transperineal prostate biopsy: Protocol for a clinic-based surgical technique

Ilias Giannakodimos1* Napoleon Moulavasilis2 Aris Kaltsas1 Dionysios Mitropoulos2 Michael Chrisofos1 Konstantinos Stravodimos2 Evangelos Fragkiadis2
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1 Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
2 Department of Urology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
Submitted: 11 November 2024 | Revised: 20 January 2025 | Accepted: 14 February 2025 | Published: 7 March 2025
© 2025 by the Journal of Biological Methods published by POL Scientific. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Background: Prostate biopsy is a crucial diagnostic tool for detecting clinically significant prostate cancer (csPCa). Traditional transrectal ultrasound (TRUS)-guided biopsy methods are often associated with an increased infection risk of infection and limited accuracy, particularly when diagnosing anterior lesions of the prostate gland. Objective: This article presented a structured protocol for performing transperineal fusion magnetic resonance imaging/ultrasound (MRI/US) prostate biopsy, highlighting its advantages over the TRUS approach. Our study included biopsy-naïve patients with elevated prostate-specific antigen levels or abnormal digital rectal examination findings, all of whom underwent pre-biopsy multiparametric MRI to guide targeted biopsies. The key objectives of this protocol were to improve the detection rates of csPCa, minimize infection risk, and standardize a transperineal technique that combines both systematic and targeted biopsies. In addition, we provided details on patient preparation, equipment requirements, procedural steps, and follow-up protocols to ensure the safety and effectiveness of the procedure. This protocol aims to serve as a guideline for institutions to adopt MRI/US fusion-guided transperineal biopsy, thereby enhancing diagnostic accuracy and patient safety. Conclusion: The transperineal fusion MRI/US biopsy protocol enhances diagnostic accuracy, particularly for anterior lesions, while reducing infections risks. Combining targeted and systematic biopsies improves detection rates of csPCa and offers a standardized, safe approach for clinical implementation.

Keywords
Prostate biopsy
Transperineal approach
Fusion magnetic resonance imaging/ultrasound
Prostate cancer
Diagnostic protocol
Infection reduction
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
References
  1. Cornford P, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer-2024 update. Part I: Screening, diagnosis, and local treatment with curative intent. Eur Urol. 2024;86(2):148-63. doi: 10.1016/j.eururo.2024.03.027

 

  1. Tu X, Liu Z, Chang T, et al. Transperineal magnetic resonance imaging-targeted biopsy may perform better than transrectal route in the detection of clinically significant prostate cancer: Systematic review and meta-analysis. Clin Genitourin Cancer. 2019;17(5):e860-e870. doi: 10.1016/j.clgc.2019.05.006

 

  1. Wu F, Gao J, Kang J, et al. Knowledge mapping of exosomes in autoimmune diseases: A bibliometric analysis (2002-2021). Front Immunol. 2022;13:939433. doi: 10.3389/fimmu.2022.939433

 

  1. Pepe P, Pennisi M. Morbidity following transperineal prostate biopsy: Our experience in 8.500 men. Arch Ital Urol Androl. 2022;94(2):155-159. doi: 10.4081/aiua.2022.2.155

 

  1. Eldred-Evans D, Burak P, Connor MJ, et al. Population-based prostate cancer screening with magnetic resonance imaging or ultrasonography: The IP1-PROSTAGRAM study. JAMA Oncol. 2021;7(3):395-402. doi: 10.1001/jamaoncol.2020.7456

 

  1. Emmett L, Buteau J, Papa N, Moon D, et al. The additive diagnostic value of prostate-specific membrane antigen positron emission tomography computed tomography to multiparametric magnetic resonance imaging triage in the diagnosis of prostate cancer (PRIMARY): A prospective multicentre study. Eur Urol. 2021;80(6):682-689. doi: 10.1016/j.eururo.2021.08.002

 

  1. Klotz L, Chin J, Black PC, et al. Comparison of multiparametric magnetic resonance imaging-targeted biopsy with systematic transrectal ultrasonography biopsy for biopsy-naive men at risk for prostate cancer: A phase 3 randomized clinical trial. JAMA Oncol. 2021;7(4):534-542. doi: 10.1001/jamaoncol.2020.7589

 

  1. Wegelin O, Exterkate L, van der Leest M, et al. The FUTURE trial: A multicenter randomised controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies. Eur Urol. 2019;75(4):582-590. doi: 10.1016/j.eururo.2018.11.040

 

  1. Corfield J, Perera M, Bolton D, Lawrentschuk N. (68)Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: A systematic review. World J Urol. 2018;36(4):519-527. doi: 10.1007/s00345-018-2182-1

 

  1. Rai BP, Mayerhofer C, Somani BK, Kallidonis P, Nagele U, Tokas T. Magnetic resonance imaging/ultrasound fusion-guided transperineal versus magnetic resonance imaging/ultrasound fusion-guided transrectal prostate biopsy-a systematic review. Eur Urol Oncol. 2021;4(6):904-913. doi: 10.1016/j.euo.2020.12.012

 

  1. Gunzel K, Magheli A, Baco E, et al. Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis. World J Urol. 2021;39(10):3861-3866. doi: 10.1007/s00345-021-03699-1

 

  1. Thomson A, Li M, Grummet J, Sengupta S. Transperineal prostate biopsy: A review of technique. Transl Androl Urol. 2020;9(6):3009-3017. doi: 10.21037/tau.2019.12.40

 

  1. Bryant RJ, Yamamoto H, Eddy B, et al. Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique. BJU Int. 2023;131(6):694-704. doi: 10.1111/bju.15978

 

  1. Bennett HY, Roberts MJ, Doi SA, Gardiner RA. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect. 2016;144(8):1784-1791. doi: 10.1017/S0950268815002885

 

  1. Xue J, Qin Z, Cai H, et al. Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: A meta-analysis and trial sequential analysis. Oncotarget. 2017;8(14):23322-23336. doi: 10.18632/oncotarget.15056

 

  1. Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: A systematic review and meta-analysis. World J Surg Oncol. 2019;17(1):31. doi: 10.1186/s12957-019-1573-0

 

  1. Hu JC, Assel M, Allaf ME, et al. Transperineal versus transrectal magnetic resonance imaging-targeted and systematic prostate biopsy to prevent infectious complications: The PREVENT randomized trial. Eur Urol. 2024;86(1):61-68. doi: 10.1016/j.eururo.2023.12.015

 

  1. Uleri A, Baboudjian M, Tedde A, et al. Is there an impact of transperineal versus transrectal magnetic resonance imaging-targeted biopsy in clinically significant prostate cancer detection rate? A systematic review and meta-analysis. Eur Urol Oncol. 2023;6(6):621-628. doi: 10.1016/j.euo.2023.08.001

 

  1. van der Leest M, Cornel E, Israel B, et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: A large prospective multicenter clinical study. Eur Urol. 2019;75(4):570-578. doi: 10.1016/j.eururo.2018.11.023

 

  1. Drost FH, Osses DF, Nieboer D, et al. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev. 2019;4(4):CD012663. doi: 10.1002/14651858.CD012663.pub2

 

  1. Rouviere O, Puech P, Renard-Penna R, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): A prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019;20(1):100-109. doi: 10.1016/S1470-2045(18)30569-2

 

  1. Miah S, Hosking-Jervis F, Connor MJ, et al. A multicentre analysis of the detection of clinically significant prostate cancer following transperineal image-fusion targeted and nontargeted systematic prostate biopsy in men at risk. Eur Urol Oncol. 2020;3(3):262-269. doi: 10.1016/j.euo.2019.03.005

 

  1. Kesch C, Hansen N, Barrett T, et al. PD43-02 multicentre comparison of target and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. J Urol. 2017;197:e818. doi: 10.1016/j.juro.2017.02.1907

 

  1. Brisbane WG, Priester AM, Ballon J, et al. Targeted prostate biopsy: Umbra, penumbra, and value of perilesional sampling. Eur Urol. 2022;82(3):303-310. doi: 10.1016/j.eururo.2022.01.008

 

  1. Touzani A, Fiard G, Barret E, et al. Clinical trial protocol for PERFECT: A randomised controlled trial comparing the efficiency and tolerance of transperineal fusion versus transrectal imaging-targeted prostate biopsies (CCAFU-PR1 Study). Eur Urol Open Sci. 2022;45:76-80. doi: 10.1016/j.euros.2022.09.007

 

  1. Kench JG, Judge M, Delahunt B, et al. Dataset for the reporting of prostate carcinoma in radical prostatectomy specimens: Updated recommendations from the International Collaboration on Cancer Reporting. Virchows Arch. 2019;475(3):263-277. doi: 10.1007/s00428-019-02574-0
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Journal of Biological Methods, Electronic ISSN: 2326-9901 Print ISSN: TBA, Published by POL Scientific