Outcomes of transperineal template‐guided prostate biopsy in 409 patients

Abstract

What's known on the subject? and What does the study add?• With an aging population and routine use of PSA testing, there is an increase in men undergoing biopsy to assess for prostate cancer. The most common route for accessing the prostate is through the rectum, which potentially exposes the patient to otherwise innocuous Enterobacteriaceae. The rising incidence of extended-spectrum beta-lactamase has been linked to a rise in post-TRUS biopsy infection rates internationally.• The study describes an alternative route for biopsy of the prostate that is associated with a very low infection rate, whilst still maintaining a good tumour detection rate. Objective• To present the template-guided transperineal prostate biopsy (TPB) outcomes for patients of two urologists from a single institution. Patients and Methods• We conducted a prospective study of 409 consecutive men who underwent TPB between December 2006 and June 2008 in a tertiary referral centre using a standardized 14-region technique.• The procedure was performed as day surgery under general anaesthesia with fluoroquinolone antibiotic cover.• Follow-up took place within 2 weeks, during which time men were interviewed using a standardized template.• Results were compared with those of the Australian national prostate biopsy audits performed by the Urological Society of Australia and New Zealand (USANZ). Results• Indications for biopsy included elevated prostate-specific antigen (PSA) level (75%), with a median PSA level of 6.5 ng/mL, abnormal digital rectal examination (8%) and active surveillance (AS) re-staging (18%).• The mean patient age was 63 years and two-thirds of patients were undergoing their first biopsy. • A positive biopsy was found in 232 men, 74% of whom had a Gleason score of Ն7. The overall cancer detection rate was 56.7% (USANZ 2005 national audit = 56.5%).Stratified between those having their first TPB or a repeat procedure (after a previous negative biopsy), the detection rates were 64.4 and 35.6%, respectively. Significantly higher detection rates were found in prostates <50 mL in volume than in larger prostates (65.2 vs 38.3%, respectively, P < 0.001).• Haematuria was the most common side effect (51.7%).Others included dysuria (16.4%), acute urinary retention (4.2%) and fever (3.2%). One patient (0.2%) had septicaemia requiring i.v. antibiotics. • Repeat biopsy was not associated with increased complication rates. Conclusions• TPB is a safe and efficacious technique, with a cancer detection rate of 56.7% in the present series, and a low incidence of major side effects. Stratified by prostate volume, the detection rate of TPB was higher in smaller glands.• Given the relatively low rate of serious complications, clinicians could consider increasing the number of TPB biopsy cores in larger prostates as a strategy to improve cancer detection within this group. Conversely, in patients on AS programmes, a staging TPB may be a superior approach for patients undergoing repeat biopsy so as to minimize their risk of serious infection.

Transperineal In-Bore 3-T MR Imaging–guided Prostate Biopsy: A Prospective Clinical Observational Study

“…The lack of postbiopsy infection or sepsis is important in contrast to the 3%-11% infection rates previously reported for transrectal US, especially in light of rising antibiotic-resistant infections after transrectal biopsies (46)(47)(48). It can be performed in men with difficult or impossible rectal access, such as patients who have undergone proctocolectomy or those with rectal stenosis from prior radiation treatment (49).…”

Transperineal template-guided saturation biopsy aimed at sampling one core for each milliliter of prostate volume: 103 cases requiring repeat prostate biopsy

“…Studies including more than 100 cases have reported detection rates of 35.6–54.8% [9, 10, 18, 22, 28, 29]. Although the technique of TTSB and the number of biopsy cores varied among these studies, the cancer detection rate in repeated biopsy patients was almost similar.…”

“…Prostate volume has been considered a negative predictor of positive PCa by transperineal prostate biopsy in other reports [10, 28]. Merrick et al used a 24-region technique with a median (mean, range) of 50.0 (51.1, 24–66) biopsy cores for patients whose mean prostate volume was 78.6 ml [10].…”

“…Merrick et al used a 24-region technique with a median (mean, range) of 50.0 (51.1, 24–66) biopsy cores for patients whose mean prostate volume was 78.6 ml [10]. Symons et al used a 14-region technique with a median (mean, range) of 15 (19.2, 4–47) biopsy cores for patients whose mean prostate volume was 45.8 ml [28]. In the present study, larger prostate volume predicted negative for PCa [odds ratio (OR), 0.29; 95%CI, 0.09–0.90] with a median (mean, range) of 37 (40.2, 18–75) biopsy cores for patients whose mean prostate volume was 38.5 ml.…”

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

“…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.…”