Indications, results and safety profile of transperineal sector biopsies (TPSB) of the prostate: a single centre experience of 634 cases

Abstract

Objective• To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population. Patients and Methods• A retrospective review of a single-centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24-38 cores using a 'sector plan' . Procedures were carried out under general anaesthetic in most patients.• Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low-risk disease diagnosed based on a 12-core TRB (307). Results• Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors.• As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL).• Of men with Gleason 3+3 disease on TRB, 29%were upgraded and went on to have radical treatment.• Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per-urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis. Conclusions• TPSB of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity.

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

“…In addition, this study clearly showed that the biopsy density matters, as the agreement between biopsy and whole-mount histology results was significantly lower in the larger prostate, in which the biopsy density was lower. Other groups use protocols that preferentially sample the peripheral area while performing limited sampling of the anterior part of the prostate [12,13]. In our study, avoiding the sampling of the transition zone led to a decrease in sensitivity and negative predictive value for clinically significant disease of over 20%.…”

“…However, transperineal biopsies can be performed in a number of different ways with varying biopsy densities. These can generally be categorised into those that first, map the prostate by taking biopsies every 5mm [8][9][10][11] or second, those that sample regions of the prostate but with reduced density of cores [12][13][14][15]. Whilst computer simulation studies demonstrate less sensitivity in detecting lesions that are >0.5cc or >0.2cc in volume when using a 10mm sampling frame compared to taking biopsies every 5mm [16], it is not known whether this is the case in patients.…”

Complications After Systematic, Random, and Image-guided Prostate Biopsy

“…Namekawa et al, recently reported on 2.086 men undergoing an initial PB under lumbar spinal anesthesia: PSA , IPSS score, prostate volume, abnormal DRE and history of α-blocker use were independent predictors of LUTS and urinary retention 13 . When compared to TRUS-guided PB, the occurrence of acute urinary retention after transperineal approach is slightly higher, ranging from 1.7% to 11.1% [8][9][10]25,26 . Pepe et al reported 11.1%, which was significantly correlated with the number of cores taken 10,27 .…”

“…However, in a biopsy-based multivariable analysis, the repeat biopsy procedure itself was not associated with a greater risk of serious complications requiring hospital admission compared to the initial biopsy session 59 . In patients undergoing transperineal PB, the reported incidence of infections and sepsis is close to zero (0-0.2%), given the avoidance of bacterial contamination (which is common during transrectal access), as well as the limited number of cores taken when performing transperineal MRI-guided in bore biopsy [8][9][10]13,[25][26][27]29,[63][64][65][66][67] . Although data are currently limited, it is uncertain whether the lower incidence of infectious complications after MRI-targeted PB could be related to the sampling route (i.e.…”

“…A recent statewide study from the Michigan Urological Surgery Improvement Collaborative (MUSIC) group, reported a reduction in hospitalization rates for infectious complications from 1.19% to 0.56%, when adopting a specific protocol for antibiotic prophylaxis (by shifting from a monotherapy to a multi-drug prophylaxis or performing culture-directed prophylaxis) 51 . Although transperineal approach for PB is infrequently used in many parts of the world largely due to logistical reasons, the incidence of re-admissions for urinary infection or sepsis is lower, ranging from 0% to 0.7% in published reports 9,10,25,26 (Table 2).Despite the currently limited available body of literature, the lower incidence of infections and hospitalizations among patients undergoing MRI-targeted PB appears mostly related to the transperineal access, rather than the number of cores taken 29,64 . In summary, the occurrence of serious major complications after transrectal PB requiring hospital admission, ranges from 0.5% to 6.9%, and has increased over time.…”