To define the learning curve of the in-office, freehand MRI-ultrasound cognitive fusion transperineal prostate biopsy (CTPB) by assessing cancer detection, biopsy core quantity and quality, procedure times, and complications over the initial experience.
We reviewed 110 consecutive CTPB performed March 2021-September 2022 by a urologist inexperienced with the PrecisionPoint® platform. The study period was divided into quarters to assess for temporal variation in outcomes. Univariable and multivariable analysis modeled the learning curve.
Across quarters, there were no differences in the detection of clinically significant prostate cancer (Q1:50%, Q2:52%, Q3:50%, Q4:48%, p>0.9) or Gleason grade group upgrading by targeted versus systematic biopsy (p=0.6). Median procedure times improved with experience (Q1:17min, Q2:14min, Q3:12min, Q4:13min, p=0.018). On multivariable analysis, procedure times decreased by one minute per 20 cases (p<0.001). On linear regression, CTPB procedure times approximated transrectal biopsy times after 90 cases (p<0.001). The histopathologic core quality did not differ, as evidenced by consistent core length (p=0.13) and presence of minimal fibromuscular tissue (p>0.9).The most common complications, hematuria and hematospermia, were similar across quarters (p=0.7, p=0.3, respectively). There was a single episode of urinary retention and no reported infections.
There is no evidence of a learning curve for CTPB as shown by consistent clinically significant prostate cancer detection, high quality biopsy cores, and low complications. However, CTPB procedural times begin to approximate cognitive targeted transrectal biopsy times after 90 cases.
Urology. 2023 Aug 12 [Epub ahead of print]
Sofia Gereta, Michael Hung, Mohammad K Alexanderani, Brian D Robinson, Jim C Hu
Department of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA; Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA., Department of Pathology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA. Electronic address: .