Photo Credit: Dr Microbe
The following is a summary of “Novel Prostate Biopsy Technique Using Imaging Fusion in a Patient With Absent Rectum,” published in the February 2024 issue of Urology by Sawyer et al.
This study outlines a pioneering approach employing pre-operative multi-parametric prostate MRI and intraoperative CT 3D/3D fusion for systematic and targeted prostate biopsy in a patient with rectal absence.
A 70-year-old male, who had undergone total colectomy for ulcerative colitis, presented with elevated PSA (8.01) and a PIRADS 4 lesion on MRI. Using a robotic-armed fluoroscopy system (Artis Zeego Care+Clear™, Siemens), an ultra-low-dose (ULD) cone beam CT was conducted in a supine position under general anesthesia. The MRI and ULD CT images were auto-registered in 3D/3D, identifying prostate edges and areas of concern. Subsequently, a transperineal prostate biopsy was performed under reduced-dose fluoroscopy guidance using a triangulation technique.
A total of 27 prostate biopsy cores were obtained, revealing Grade Group 5 (Gleason 4+5=9) prostate cancer in two cores from the targeted lesion and one core from the prostate base. The remaining twenty-four biopsies were negative for malignancy. The surgical time was 81 minutes. PSMA scan results indicated no metastasis or lymphadenopathy. A robotic-assisted laparoscopic radical prostatectomy was executed without complications, and the final pathology revealed T3a, grade group 5 prostate adenocarcinoma involving 10% of the prostate volume with negative surgical margins.
This report presents the first use of fluoroscopy-guided prostate biopsy with imaging fusion in a patient without a rectum. The technique facilitated precise identification of localized, very high-risk prostate cancer, obtaining over three times the number of cores with much lower radiation dose compared to typical CT-guided biopsies. This approach introduces a potential shift in the paradigm for targeted prostate biopsy.
Source: sciencedirect.com/science/article/abs/pii/S0090429524000207
