Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Abstract

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

Point of View: Innovation and Progress for Screening and Management of Localized Prostate Cancer: What an Exciting Time

“…Providing 300% improved resolution relative to conventional ultrasound, microultrasound appears to improve targeted sampling and provide a high NPV in the absence of abnormalities. 10 Early comparison with mpMRI suggests equivalent cancer detection with microultrasound, 10 offering promise as a single modality for imaging and sampling. The ability of microultrasound to deliver on this promise will be further informed by the ongoing OPTIMUM trial.…”