MP26-02: Role of Anterior Prostate Sampling Using a Novel Philadelphia Hybrid Anatomic Transperineal (PHAT) Template: A single center experience.

Saturday, September 11, 2021 5:30 PM to 7:30 PM


Authors: Johnathan Drevik, Adams Ako, Jeffrey Ellis, Phillip Abbosh, Jay Simhan, Justin Friedlander, Steven Sterious, Joshua Cohn, Robert Uzzo, Serge Ginzburg

Introduction: Transperineal prostate biopsy approach has become more widespread due to lower rate of post-biopsy infections and better anterior gland sampling. Despite its increasing adoption, no universal transperineal template exists and the role of routine anterior gland sampling remains undefined.  Here we propose a simplified office-based transperineal biopsy template and describe cancer distribution and the relevance of anterior cores.

Methods: A retrospective chart review of patients that underwent PHAT template transperineal biopsy (Figure 1a) between November 2017 through November 2020 was performed and clinicopathologic data along with relevant multiparametric MRI (mpMRI) data were abstracted.   In patients with multiple biopsies only the initial systematic biopsy was included. Clinically significant cancer (csCa) was defined as = GG2.  Descriptive statistics were utilized to evaluate cancer detection rate and location.

Results: 178 unique patients (median age 64.0, IQR 10, median PSA 9.2, IQR 4.7) comprised the cohort of interest. 148 (83%) were performed in the office under local analgesia. Overall, cancer detection rate (CDR) was 140/178 (79%), while csCa was present in 94/178 (52.8%) The distribution of detected cancer using the PHAT template can be seen in Figure 1b.  Cancer in anterior cores only was observed in 21 (11.8%) men, with 57.1% being csCa. mpMRI was available for 13 of 21 (61.9%) patients with anterior-only prostate cancer, of which 8/13 (61.5%) had no anterior lesions detected on MRI. Morbidity of this remained remained low, without any episodes of sepsis.

Conclusions: The PHAT prostate biopsy template provides a high CDR and allows for comprehensive anterior gland sampling with minimal morbidity.  Importance of routine anterior gland sampling is underscored, as 2/3 of anterior-only cancers would be missed if mpMRI alone was used to triage anterior gland targeting.

Source of Funding: None

Therapeutic Area
Oncology: Prostate