Mahir Bülent Özgen

Outcomes of fecal carriage of extended-spectrum β-lactamase after transrectal ultrasound-guided biopsy of the prostate.

OBJECTIVE To determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (PE) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy (TRUSbx) and its relationship with post-biopsy infections. METHODS A prospective clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted. Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy. Rectal swab culture specimens were acquired immediately before the procedure. Demographic data, prophylaxis choice, quinolone or any other antibiotic consumption within the past 2 months, history of prostatitis, repeat biopsy, intensive care unit admission, hospitalization, urethral catheterization, diabetes mellitus (DM), and steroid usage were recorded. RESULTS ESBL carriage was detected in 19% of patients and quinolone use within the last 2 months; other antibiotic use within the last 2 months and DM were found to be significantly associated (P <.05). Symptomatic urinary tract infection (UTI) on the third day after biopsy was seen in 9% of patients and was associated with fluoroquinolone (FQ) consumption before biopsy. Although ESBL-PE carriage was associated with post-biopsy UTI symptoms, it was not found to be associated with post-biopsy symptomatic UTI. Urosepsis was seen in 2 patients (0.5%) after biopsy, and both the patients were ESBL-PE carriers. CONCLUSION The presence of ESBL-PE was associated with DM and FQ consumption before biopsy. ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation; however, it was not associated with microbiologically proven infections. FQ consumption before TRUSbx was also associated with post-biopsy infections.

Initial Outcomes and Assessment of the Transperineal Multiparametric-Magnetic Resonance Imaging/Ultrasonography Fusion Biopsy Method in Diagnosing Clinically-significant Prostate Cancer

Ya z›fl ma Ad re si/Ad dress for Cor res pon den ce: Dr. Mahir B. Özgen, Acıbadem Kadıköy Hastanesi, Üroloji Kliniği, İstanbul, Türkiye Tel.: +90 216 544 42 76 E-mail: ozgenmahir@hotmail.com Ge liş Ta ri hi/Re cei ved: 30.12.2016 Ka bul Ta ri hi/Ac cep ted: 13.03.2017 Objective: In this study, it was aimed to investigate the success of transperineal multiparametric magnetic resonance imaging (mp-MRI)/ transrectal ultrasonography (USG) fusion prostate biopsy method in prostate cancer diagnosis and detection of clinically significant cancer. Materials and Methods: All patients signed written informed consent then patients with an indication for prostate cancer, therefore biopsy was planned for the last year underwent 3 Tesla mp-MRI retrospectively. All the lesions of patients with Prostate Imaging, Reporting and Data System (PIRADS) 3, 4 and 5 lesions were marked using MIMTM Symphony software by a single radiologist. All patients underwent transperineal MRI/USG fusion biopsy under general anesthesia. In the prostate MRI evaluation of the targeted lesions with a PIRADS score of 3-4-5 were sampled with 2 to 5 cores followed by random biopsies of both of the prostate lobes. Results: Prostate adenocarcinoma was diagnosed in 20 of 59 patients (33.8%) having fusion biopsy. No difference was observed in prostatespecific antigen levels of patients whose biopsy results were benign and malignant. In 63% of patients, only PIRADS 3 lesions were found, whereas PIRADS 4 and/or 5 lesions were reported in 22 (37%) patients. The fusion biopsy of PIRADS 3 lesions revealed cancer in 7 patients (19%), of which 6 had clinically-insignificant prostate cancer criteria. Adenocarcinoma was diagnosed in 59% who had PIRADS 4 and/or 5 lesions. All these tumors had clinically-significant cancer characteristics. Lesion-targeted fusion biopsies missed 1 clinically-insignificant adenocarcinoma (1/7; 14.3%), while it did not miss any of the clinicallysignificant cancers. No infection was seen in post-operative period. Acute urinary retention was developed in 4 patients (6%). Amaç: Bu çalışmada, transperineal yolla yapılan multiparametrik manyetik rezonans görüntüleme (mp-MRG)/transrektal ultrasonografi (USG) füzyon biyopsi yönteminin prostat kanseri tanısı ve klinik-önemli kanseri saptamadaki başarısının araştırılması amaçlanmıştır. Gereç ve Yöntem: Hasta onamları alındıktan sonra, retrospektif olarak, son bir yıl içerisinde prostat kanseri şüphesi nedeniyle biyopsi planlanan tüm hastalara 3 Tesla mp-MRG yapıldı. Prostat Görüntüleme, Raporlama ve Data Sistemi (PIRADS) 3, 4 ve 5 lezyonu olan hastaların lezyonları tek radyolog tarafından MIMTMSymphony yazılımı kullanılarak işaretlendi. Tüm hastalara genel anestezi altında transperineal MRG/USG füzyon biyopsi uygulandı. Prostat MRG değerlendirmede PIRADS skoru 3-4-5 bildirilen lezyonlardan ortalama 2-5 kor örnekleme yapıldı ve ardından prostat her iki lobundan random biyopsiler alındı. Bulgular: Füzyon biyopsi yapılan toplam 59 hastanın 20’sinde (%33,8) prostatik adenokarsinom saptandı. Biyopsi patolojisi sonuçları benign veya malign olan hasta gruplarında prostat spesifik antijen düzeylerinde fark izlenmedi. Hastaların %63’ünde yalnız PIRADS 3 skora sahip lezyonlar saptanırken, 22 (%37) hastada PIRADS 4 ve/veya 5 skorlu lezyonlar rapor edildi. Füzyon biyopsi yapılan PIRADS 3 lezyonların 7’sinde (%19) kanser saptandı ve bunların 6’sı (%85,7) klinik-önemsiz prostat kanseri kriterlerine sahipti. PIRADS 4 ve/veya 5 lezyonları bulunan %59’unda adenokanser saptandı. Bu tümörlerin hepsi klinik-önemli kanser kriterlerini taşımaktaydı. Lezyon-hedefli füzyon biyopsiler klinik-önemsiz 1 adenokarsinomu kaçırırken (1/7; %14,3), klinik-önemli kanserlerin hiçbirini atlamadığı görüldü. Post-operatif dönemde hiçbir hastada enfeksiyon görülmedi. Dört hastada (%6) akut idrar retansiyonu gelişti. Sonuç: Füzyon biyopsi uygulamasının başlangıç döneminde elde edilen Abstract Öz 1Acıbadem Kadıköy Hastanesi, Üroloji Kliniği, İstanbul, Türkiye 2Acıbadem Üniversitesi Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye 3Acıbadem Kadıköy Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye Initial Outcomes and Assessment of the Transperineal Multiparametric-Magnetic Resonance Imaging/Ultrasonography Fusion Biopsy Method in Diagnosing Clinically-significant Prostate Cancer