Transperineal Fusion MR/Ultrasound Prostate Biopsy in the Patient with No Anus

Abstract

Introduction:

Transrectal ultrasound (TRUS)-guided prostate biopsy has long been the gold standard for obtaining tissue in the diagnosis of prostate cancer. Even as newer techniques have developed including transperineal and MR/ultrasound (US) fusion-guided biopsies, it remains technically challenging in certain patient populations: specifically, in men who have undergone total colectomy or abdominoperineal resections (APR) who do not have a rectum or anus, and those with severe anal stenosis unable to accommodate an endorectal probe for imaging or needle guidance. ^{1 –3} All current options for biopsy in these men are technically challenging and inadequate. In this video, we describe a novel technique to perform transperineal MR/US fusion-guided prostate biopsy.

Materials and Methods:

The procedure consists of MR acquisition, MR segmentation of the prostate and region of interest, ultrasound imaging of the prostate with sweep and segmentation, coregistration of the images, and finally the targeted biopsy followed by the standard of care systematic 12-core biopsy.

Results:

An example of this technique is demonstrated with a patient who after APR underwent effective fusion-guided biopsy of his PIRADS 5 MR lesion using the already described technique. Pathology report showed prostate cancer in all three cores through the region of interest and was negative in the standard 12-core biopsy. This procedure has subsequently been effectively completed in six additional patients.

Conclusions:

In conclusion, transperineal MR/US fusion-guided prostate biopsy is a novel, feasible, and safe procedure extending the benefits of prostate MRI and targeted biopsy to men who cannot undergo TRUS.

Dr. Kastner and Dr. Rastinehad both have funding from Philips. Dr. Rastinehad does consulting for Philips and receives funding from them for a research trial. Dr. Kastner's department has received grants to run MRI courses from Philips.

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Runtime of video: 7 mins 37 secs

Presented at the American Urological Association Annual Meeting in May 21, 2018 in San Francisco, California.