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LETTERS TO EDITOR
Year : 2022  |  Volume : 38  |  Issue : 3  |  Page : 242-243
 

Re: Sivaraman A, Ramasamy V, Aarthy P, Sankar V, Sivaraman PB. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience. Indian J Urol 2022;38:34-41


Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey

Date of Submission20-Mar-2022
Date of Acceptance04-May-2022
Date of Web Publication1-Jul-2022

Correspondence Address:
Akif Erbin
Department of Urology, Haseki Traning and Research Hospital, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_92_22

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How to cite this article:
Erbin A, Erdal FS. Re: Sivaraman A, Ramasamy V, Aarthy P, Sankar V, Sivaraman PB. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience. Indian J Urol 2022;38:34-41. Indian J Urol 2022;38:242-3

How to cite this URL:
Erbin A, Erdal FS. Re: Sivaraman A, Ramasamy V, Aarthy P, Sankar V, Sivaraman PB. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience. Indian J Urol 2022;38:34-41. Indian J Urol [serial online] 2022 [cited 2022 Aug 9];38:242-3. Available from: https://www.indianjurol.com/text.asp?2022/38/3/242/349702




We read with great interest the newly published study on freehand transperineal prostate biopsy, published in the journal.[1] I congratulate the researchers for making an important contribution to the literature and clinical practice on cognitive fusion biopsy. In the present study, the authors shared the results of freehand transperineal cognitive fusion biopsy using the PrecisionPoint device (PrecisionPoint™ BXTAccelyon) in 50 patients and reported that this technique has satisfactory cancer (overall; 82% and clinical significant prostate cancer [CSPC]; 78%) rates and acceptable complications.

Three types of targeted biopsy techniques based on multiparametric-magnetic resonance imaging (Mp-MRI) have been developed so far; mp-MRI/TRUS fusion biopsy, direct MRI-guided (in-bore) biopsy, and cognitive fusion biopsy.

In a recent meta-analysis comparing the three targeted biopsy techniques, it was reported that all three techniques had similar CSPC detection rates.[2] Similarly, in the current (2022) guideline of the European Association of Urology, it is stated that in cases where a suspicious lesion is observed on mp-MRI, either mp-MRI/TRUS fusion biopsy, in-bore biopsy, or cognitive fusion biopsy can be used.[3] Of these three techniques, mp-MRI/TRUS fusion biopsy and in-bore biopsy have a major cost problem as they require additional software. However, there is no serious cost problem with cognitive fusion biopsy. Despite all this, cognitive fusion biopsy has been much less accepted by physicians and patients and has found less place in the literature and clinical practice. At this point, the influence of the industry is a fact that cannot be ignored.

Although it remains in the background in the literature, there have been some important developments in cognitive fusion biopsy. Using smart glasses and various simple coordinate-based methods, it has been shown that this method can have better results.[4],[5],[6] In addition, it was reported that cognitive fusion biopsy, which was previously performed entirely through the transrectal route, can also be performed by the transperineal route, which has a significant advantage in terms of local anesthesia requirement and infective complications, especially urosepsis.[7] However, a freehand transperineal cognitive fusion biopsy technique was defined with a simple instrument (PrecisionPoint device) without the need for a template unit.[8]

As authors, we attach great importance to this technique (freehand transperineal cognitive fusion prostate biopsy) reported by researchers in terms of both not being under the influence of the entire industry and lowering infective complications. I would like to emphasize that freehand transperineal cognitive fusion biopsy should become widespread in our clinical practice and that our experience in this field should increase, especially for clinics that do not have mp-MRI/TRUS fusion biopsy and in-bore biopsy devices due to cost. Otherwise, our prostate fusion biopsy practices will not be shaped in the light of scientific facts but will be shaped entirely by the influence of the industry.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.



 
   References Top

1.
Sivaraman A, Ramasamy V, Aarthy P, Sankar V, Sivaraman PB. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience. Indian J Urol 2022;38:34-41.  Back to cited text no. 1
  [Full text]  
2.
Wegelin O, van Melick HH, Hooft L, Bosch JL, Reitsma HB, Barentsz JO, et al. Comparing three different techniques for MRI-targeted prostate biopsies: A systematic review of in-bore versus MRI-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 2017;71:517-31.  Back to cited text no. 2
    
3.
Mottet N, Cornford P, van den Bergh RC, Briers E, Santis M, Gillessen S, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer. Eur Assoc Urol 2022;5:21-34.  Back to cited text no. 3
    
4.
Sparwasser P, Haack M, Epple S, Frey L, Zeymer S, Dotzauer R, et al. Smartglass augmented reality-assisted targeted prostate biopsy using cognitive point-of-care fusion technology. Int J Med Robot 2022;18:e2366.  Back to cited text no. 4
    
5.
Clement KD, Day L, Rooney H, Neilson M, Birrell F, Salji M, et al. Developing a coordinate-based strategy to support cognitive targeted prostate biopsies and correlative spatial-histopathological outcome analysis. Asian J Androl 2021;23:231-5.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Wang L, Wang X, Zhao W, Zhao Z, Li Z, Fei S, et al. Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate: An original technique with a good cancer detection rate. BMC Urol 2019;19:107.  Back to cited text no. 6
    
7.
Salagierski M, Kania P, Wierzchołowski W, Poźniak-Balicka R. The role of a template-assisted cognitive transperineal prostate biopsy technique in patients with benign transrectal prostate biopsies: A preliminary experience. Cent European J Urol 2019;72:15-8.  Back to cited text no. 7
    
8.
Meyer AR, Joice GA, Schwen ZR, Partin AW, Allaf ME, Gorin MA. Initial experience performing in-office ultrasound-guided transperineal prostate biopsy under local anesthesia using the precisionpoint transperineal access system. Urology 2018;115:8-13.  Back to cited text no. 8
    




 

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