Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

Abstract

Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.

Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System

“…One critique of the analysed literature on the PrecisionPoint device is the relative lack of direct comparisons between use of this device and other various methods for performing transperineal prostate biopsy. With that said, the literature has consistently shown a benefit in terms of shorter procedure times with the PrecisionPoint device as compared to grid‐based techniques 10,17 . Another critique of the present analysis is that the advantages associated with use of PrecisionPoint are likely more attributable to the transperineal approach in general, and not use of the device itself.…”

“…With that said, the literature has consistently shown a benefit in terms of shorter procedure times with the PrecisionPoint device as compared to grid‐based techniques. 10 , 17 Another critique of the present analysis is that the advantages associated with use of PrecisionPoint are likely more attributable to the transperineal approach in general, and not use of the device itself. With that said, within the broad category of freehand techniques for performing transperineal prostate, there is evidence supporting the need for a “device‐driven” approach that incorporates a needle guide that is directly coupled to the ultrasound probe.…”

“…In recent years, the limitations of the original freehand technique for performing transperineal prostate biopsy have been overcome by the introduction of a purpose‐built, probe‐mounted needle guide that includes a common access cannula known as the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD). 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Following its approval by the United States Food and Drug Administration in 2016, this device facilitated the rapid adoption of transperineal prostate biopsy worldwide and led to widespread calls for the complete abandonment of the transrectal approach to prostate biopsy. 25 , 26 In this report, we provide the results of a systematic review of the available literature on the outcomes and complications of performing transperineal prostate biopsies using this novel device.…”

BJUI Compass 2021 year‐end review

“…• To the Future… We previously touched upon the transperineal biopsy as a method of selecting patients for focal therapy. In the article by Hogan et al, 9…”

“… To the Future … We previously touched upon the transperineal biopsy as a method of selecting patients for focal therapy. In the article by Hogan et al, 9 we feature the technique of this biopsy along with the anesthesia strategy. In this prospective cohort study, the authors show tolerability for local anesthesia only—in addition to shorter procedure time, recovery time, and total time in facility.…”