Simple and effective local anesthesia for transperineal extended prostate biopsy: Application to three‐dimensional 26‐core biopsy

Kubo, Yuichi; Kawakami, Satoru; Numao, Noboru; Takazawa, Ryoji; Fujii, Yasuhisa; Masuda, Hitoshi; Tsujii, Toshihiko; Kihara, Kazunori

doi:10.1111/j.1442-2042.2009.02269.x

Cited by 52 publications

(39 citation statements)

References 18 publications

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“…Given the routine use of local anaesthesia in transrectal biopsy, a major drawback of transperineal biopsy had been the lack of a reliable and reproducible local anaesthetic method. To this end, we have reported on a simple and effective local anaesthetic method, a peri‐apical triangle block, for transperineal extended biopsy . We have confirmed the reproducible anaesthetic effect of a combination of the peri‐apical triangle block with a periprostatic nerve block in an expanded cohort receiving 3D biopsy prospectively .…”

Section: Discussionmentioning

confidence: 68%

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Diagnostic performance and safety of a three‐dimensional 14‐core systematic biopsy method

et al. 2014

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ObjectiveTo investigate the diagnostic performance and safety of a three-dimensional 14-core biopsy (3D14PBx) method, which is a combination of the transrectal six-core and transperineal eight-core biopsy methods. Patients and MethodsBetween December 2005 and August 2010, 1103 men underwent 3D14PBx at our institutions and were analysed prospectively. Biopsy criteria included a PSA level of 2.5-20 ng/mL or abnormal digital rectal examination (DRE) findings, or both. The primary endpoint of the study was diagnostic performance and the secondary endpoint was safety. We applied recursive partitioning to the entire study cohort to delineate the unique contribution of each sampling site to overall and clinically significant cancer detection. ResultsProstate cancer was detected in 503 of the 1103 patients (45.6%). Age, family history of prostate cancer, DRE, PSA, percentage of free PSA and prostate volume were associated with the positive biopsy results significantly and independently. Of the 503 cancers detected, 39 (7.8%) were clinically locally advanced (≥cT3a), 348 (69%) had a biopsy Gleason score (GS) of ≥7, and 463 (92%) met the definition of biopsy-based significant cancer. Recursive partitioning analysis showed that each sampling site contributed uniquely to both the overall and the biopsy-based significant cancer detection rate of the 3D14PBx method. The overall cancer-positive rate of each sampling site ranged from 14.5% in the transrectal far lateral base to 22.8% in the transrectal far lateral apex. As of August 2010, 210 patients (42%) had undergone radical prostatectomy, of whom 55 (26%) were found to have pathologically non-organ-confined disease, 174 (83%) had prostatectomy GS ≥7 and 185 (88%) met the definition of prostatectomy-based significant cancer. ConclusionsThis is the first prospective analysis of the diagnostic performance of an extended biopsy method, which is a simplified version of the somewhat redundant super-extended three-dimensional 26-core biopsy. As expected, each sampling site uniquely contributed not only to overall cancer detection, but also to significant cancer detection. 3D14PBx is a feasible systematic biopsy method in men with PSA <20 ng/mL.

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Section: Discussionmentioning

confidence: 68%

“…During the study period, a newly developed local anaesthetic method was introduced to replace the previous i.v. or spinal anaesthesia methods . Each biopsy core was individually labelled so that the location of cancer‐positive cores could be analysed .…”

Section: Methodsmentioning

confidence: 99%

Diagnostic performance and safety of a three‐dimensional 14‐core systematic biopsy method

et al. 2014

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“…One of the main reasons why transrectal biopsy remains the mainstay is its easiness to be carried out under local anesthesia. When applying the local anesthetic method that we reported recently, 19 both transperineal and transrectal extended biopsies, or a combination of both can be carried out under local anesthesia. Taken together, transperineal approach can be recommended as a safer alternative especially to men with considerable risk of infection such as DM.…”

Section: Discussionmentioning

confidence: 99%

Safety of transperineal 14‐core systematic prostate biopsy in diabetic men

et al. 2009

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Objectives: To examine whether the transrectal ultrasound-guided transperineal 14-core prostate biopsy can be carried out safely in diabetic men and to determine adequate antimicrobial prophylaxis protocol in this setting. Methods: The present study included 539 men, 135 with concurrent diabetes mellitus (DM) and 404 without DM, who underwent transperineal extended 14-core biopsy due to elevated prostate-specific antigen Ն2.5 ng/mL and/or abnormal digital rectal examination. Any complication requiring prolonged hospitalization or rehospitalization during the 4-week post-biopsy period was considered major. All other complications were considered minor. Intensity of antimicrobial prophylaxis was prospectively reduced in a stepwise manner down to single dose of oral levofloxacin. Results: Except for DM, there was no significant difference in clinical background between the diabetic and non-diabetic men. The procedure was completed in all revealing prostate cancer in 42% of the diabetic men and 36% of the non-diabetic men (P = 0.23). Incidence of minor or major complications was not significantly different between the two groups. Minor complications were observed in 15.6% and 16.6% of each group, respectively, with voiding disturbance being the most common. No infectious major complication was observed regardless of the presence of DM. In the diabetic men, there was no statistical difference in incidence of biopsy-related complications according to modality of DM treatment, HbA1c level or antimicrobial prophylaxis protocol. Conclusions: Transperineal 14-core biopsy can be carried out without major infectious complications in diabetic men. Oral levofloxacin 300 mg once before the procedure seems to represent an effective antimicrobial prophylaxis in diabetic men without other risk of infection.

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“…In principle, those with apparently palpable mass, age ≥75 years, PSA level ≥20 ng/mL or poor state of health were excluded from recommendation for 3D26PBx. Written informed consent was obtained from all patients and 3D26PBx was performed under spinal, general or, recently, local anaesthesia [12], as described previously [7–9]. Of these 757 patients, 42 were excluded from the current study because of palpable stage T3/4 tumours, PSA level ≥20 ng/mL or lack of baseline clinical data.…”

Section: Methodsmentioning

confidence: 99%

Characteristics and clinical significance of prostate cancers missed by initial transrectal 12‐core biopsy

et al. 2011

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Simple and effective local anesthesia for transperineal extended prostate biopsy: Application to three‐dimensional 26‐core biopsy

Cited by 52 publications

References 18 publications

Diagnostic performance and safety of a three‐dimensional 14‐core systematic biopsy method

Diagnostic performance and safety of a three‐dimensional 14‐core systematic biopsy method

Safety of transperineal 14‐core systematic prostate biopsy in diabetic men

Characteristics and clinical significance of prostate cancers missed by initial transrectal 12‐core biopsy

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