Introduction:

Introduction:

Very large prostates (>/=80 grams) present a diagnostic challenge for cancer screening.  Larger glands produce higher benign prostate-specific antigen (PSA) and malignant tumors are more challenging to localize.  These factors may contribute to more frequent biopsies and more negative biopsies. We investigated the impact of large gland size on cancer detection and complications during transperineal prostate biopsy.

Methods:

Methods: 

A consecutive cohort of transperineal (TP) biopsies at a single center between 2019 and 2020 was prospectively collected and reviewed. Biopsies were performed under general anesthesia with a standard antibiotic protocol. MR-US fusion was performed as needed.  The cohort was broken into two groups based on gland volume. Continuous data were summarized with median and 25^th-75^th percentile and compared using the Wilcoxon Sign-Rank test. Categorical/frequency variables were summarized with N and percentage, and compared with the fisher's exact test.

Results:

Results: 

101 biopsies were reviewed including 22 (22%) with gland volume >/=80 grams [Table 1]. Men with very large glands had significantly higher PSA [10.09 (7-14) vs. 5.8 (4.6-7.89), p=0.0008], were more likely to have a previous biopsy [16 (72.7%) vs. 32 (40.5%), p=0.0087] and be on active surveillance [10 (45.5%) vs. 16 (20.3%), p=0.0262].  Very large gland size had lower detection of Gleason 7 or greater [6 (27.3%) vs. 42 (53.2%), p=0.052] and higher urinary retention requiring catheterization [8(36.4%) vs. 5 (6.3%), p=0.001] including one patient who developed catheter-associated sepsis.

Conclusion:

Conclusions: 

Men with very large prostates (>/= 80 grams) undergoing TP biopsy under general anesthesia had lower detection of clinically significant cancer and high rates of post-operative urinary retention. This should be factored into biopsy selection criteria and included in patient counseling for men with very large prostate glands. 

Funding: Maimonides Research and Development Grant