Chap109N Prostate biopsy Techniques and Imaging

  1. Deficiencies of TRUS biopsy? *
    • Risk of infection 
    • Unguided 'blind' biopsy - Prostate cancer is the only solid tumor diagnosed without image guidance in the hopes of accidentally hitting the tumor
    • - Overdiagnosis / Underdiagnosis
  2. PEATS? *
    • Prostate Evasive Anterior tumors. 
    • Often found late 
    • Often extracapsular 
    • If initial pathologyy GS6, 60% upgraded on subsequent biopsy
  3. Advantages of transperineal biopsies? *
    • Safer, with better access to anterior zone 
    • Avoids 'Transfecal' biopsy. 
    • No life threatening sepsis or rectal bleeding 
    • Requires Regional anesthesia / General anesthesia
  4. Indications of repeat biopsy after initial negative biopsy? *
    • Rising and/or persistently elevated PSA 
    • Supsicious DRE - 5-30% cancer risk 
    • ASAP - Atypical small acinar proliferation - 40% risk 
    • Multifocal HGPIN (multiple biopsy sites i.e >3) - 30% risk 
    • Positive mpMRI findings
  5. Templete mapping biopsy?
    • 1 core per cc of prostate (40-90 cores)
    • Transperineal + saturation + easier to sample anterior zone
  6. PROMIS trial - TRUS biopsy vs Templete biopsy? *
  7. Cores of biopsy? *
    • 24 cores for <30 cc 
    • 32 cores for 30-50 cc 
    • 38 cores for >50 cc
  8. What are the indications of MRI in prostate carcinoma? *
    For positive biopsy - staging, risk stratification in active surveillance, focal therapy 

    Negative biopsy - look for PEATS, rule out significant disease, targeted biopsies 

    Emerging indication - Prior to biopsy
  9. Can MRI  detect all prostate carcinoma?*
    • Multiparametric MRI may miss prostate cancers
    • Very dependent on center and radiologists skill/experience
    • PROMIS - 5 possible centers excluded because unable to provide sufficient quality despite expert training and support for setup
    • MRI performs better than TRUS biopsy. 
    • TRUS biopsy is still standard of care of initial biopsy
  10. PIRADS V2?
    • PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)
    • PI-RADS 2: low (clinically significant cancer is unlikely to be present)
    • PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)
    • PI-RADS 4: high (clinically significant cancer is likely to be present)
    • PI-RADS 5: very high (clinically significant cancer is highly likely to be present)
  11. USG for Biopsy? *
    BK medical USG machine
  12. What are corpora amylacea?
    • Calcifications along the surgical capsule
    • Plane between the PZ and TZ
    • Small, multiple diffuse calcifications area normal, often incidental ultrasonographic finding in the prostate and represent a result of age rather than a pathologic entity.
  13. Size of normal seminal vesical?
    • 4.5 to 5.5 cm long 
    • 2 cm in width.
  14. Normal  prostate USG image?
    Image Upload 1

    A, Transverse view. B, Sagittalview. AFS, anterior fibromuscular stroma;CZ, central zone; DV, dorsal veincomplex; EJD, ejaculatory ducts; NVB,neurovascular bundle; L, levator muscles;PZ, peripheral zone; TZ, transition zone;U, urethra.
Card Set
Chap109N Prostate biopsy Techniques and Imaging
Prostate biopsy