Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study

Area of Science:

• Urology
• Medical Simulation
• Oncology

Background:

• Systematic prostate biopsy (sPBx) aims to reduce false-negative rates for clinically significant prostate cancer.
• Freehand techniques can lead to core deviation from the intended template schema.
• Reducing deviation is crucial for accurate cancer diagnosis and timely treatment.

Purpose of the Study:

• To develop and validate a learnable technique to minimize core deviation during freehand, side-fire systematic prostate biopsy (sPBx).
• To reduce prostate biopsy (PBx) false-negatives by improving core sampling accuracy.
• To facilitate earlier diagnosis and treatment of prostate cancer.

Main Methods:

• A pitch-neutral, side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique was devised using a simulator with 3D visualization.
• Thirty-four trainees practiced the technique in a left lateral decubitus position.
• Deviation from the template and TRUS probe pitch were recorded; mastery was defined as template deviation ≤5.0 mm.

Main Results:

• Mean template deviation decreased from 8.0 ± 2.7 mm at baseline to 4.5 ± 0.6 mm after mastering the technique (P < 0.001).
• Mean absolute pitch decreased from 8.2 ± 4.1° to 4.5 ± 2.7° (P = 0.001).
• Mastery was achieved after practicing approximately 4 sets, with no significant increase in procedure time.

Conclusions:

• A pitch-neutral side-fire technique effectively reduces template deviation in simulated freehand TRUS-guided sPBx.
• This technique is teachable and learnable, with potential to reduce PBx false-negatives in clinical settings.
• The technique is already being integrated into urology residency training programs.