Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting

Abstract

Objectives To evaluate the histopathological outcomes, morbidity and tolerability of freehand transperineal (TP) prostate biopsies using the PrecisionPoint™ access system (Perineologic, Cumberland, MD, USA) under local anaesthetic (LA) in the day surgery and outpatient environments, as systematic and targeted biopsies can be taken with the potential for reduced morbidity, particularly sepsis. Patients and Methods In all, 176 patients underwent freehand TP prostate biopsies from May 2016 to November 2017. The procedure was carried out either under LA alone or with the addition of sedation. Magnetic resonance imaging (MRI) scans were reported using the Prostate Imaging‐Reporting and Data System (PI‐RADS), version 2. Tolerability was assessed using a visual analogue scale pain score for each procedural stage. Histopathological outcomes and complications were recorded. Results The mean (range) age was 65 (36–83) years, median (range) prostate‐specific antigen level was 7.9 (0.7–1374) ng/mL, and the mean (range) prostate volume 45 (15–157) mL. Biopsies were taken under LA alone (160 patients, 90%) or under LA with sedation (16, 9%). The main indication for biopsy was primary diagnosis (88.6%). In all, 91 (52%) patients underwent systematic TP biopsies (mean 24.2 cores). Cognitive MRI‐targeted biopsies alone were performed in 45 patients (26%; mean 6.8 cores), and 40 (23%) had both systematic and target biopsies (mean 27.9 cores). Of the 75 patients who had primary systematic biopsies alone, 46 (61%) were positive, and 28/46 (60.9%) were diagnosed with clinically significant disease (Gleason ≥3+4). VAS pain scores were greatest during LA administration. There were five complications (2.8%, Clavien–Dindo Grade I/II). No patients developed urosepsis. Conclusions Freehand TP biopsies using the PrecisionPoint access system is a safe, tolerable and effective method for systematic and targeted biopsies under LA in the outpatient setting. It has replaced transrectal biopsies in our centre and has potential to transform practice.

Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases

“…A urinary retention rate of up to 24% has been reported in TP series [2,3]. This is far higher than that observed in the present study and others [2,3,11,23]. One reason for these differences is that several series used a template mapping technique, where up to 100 cores are taken in large prostates.…”

“…Third, the procedure was tolerable, with a low mean NRS score and only a small minority of patients being unable to complete the procedure. As previously reported, pain is higher during local anaesthesia and then decreases when the biopsy is being performed [10,11]. Recently, pain was evaluated in a large cohort of patients undergoing TP biopsy under local anaesthesia [12].…”

“…These studies were mainly retrospective, however, potentially missing complications. Furthermore, they often included a limited number of patients [9][10][11], were performed at single institutions using different techniques [9][10][11][12][13] or did not evaluate important aspects, including pain and/or impact on erectile and urinary function [9][10][11]. Stefanova et al [12] reported only pain outcomes for more than 1000 non-MRI-targeted biopsies.…”

Prostate cancer cells enhance interleukin‐15‐mediated expansion of NK cells

“…There is a strong rationale that intratumorally targeted immunotherapeutics will be more effective and less toxic than those that are systemically administered [30,31] and could also be used in late stage disease due to the abscopal phenomenon, where for example, IL-2 injected into melanoma lesions can clear distant metastases [32,33]. In prostate cancer, intratumoural administration is easily possible due to the availability of MRI guided biopsy technologies where needles can deliver agents accurately to the lesion, in addition to taking biopsies [34].…”

Transperineal prostate biopsy: a review of technique

“…Similar results are demonstrated in smaller published series. Kum et al published a series of 176 patients undergoing TPPB with LA in either day surgery unit (60%) or clinic setting (40%) (45). The tolerability of TPPB under LA was similar.…”