Transperineal prostate biopsy – tips for analgesia

McGrath, Shannon; Christidis, Daniel; Clarebrough, Emma; Ingle, Rahul G.; Perera, Marlon; Bolton, Damien; Lawrentschuk, Nathan

doi:10.1111/bju.13859

Cited by 25 publications

(19 citation statements)

References 5 publications

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“…A reduction to four TB cores under certain circumstances may make performing procedures under local anaesthesia achievable. Indeed, some case series have suggested that transperineal template prostate biopsy under local anaesthesia is feasible 31 .…”

Section: Discussionmentioning

confidence: 99%

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

et al. 2019

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ObjectivesTo assess cancer detection rates of different target-dependent transperineal magnetic resonance (MR)/ultrasonography (US) fusion-guided biopsy templates with reduced number of systematic cores. Patients and MethodsSingle-centre outcome of transperineal MR/US fusionguided biopsies of 487 men with a single target MR imaging (MRI) lesion, prospectively collected between 2012 and 2016. All men underwent transperineal targeted biopsy (TB) with two cores, followed by 18-24 systematic sector biopsies (SB) using the Ginsburg protocol. Gleason score ≥7 prostate cancer detection rates for two-core TB, fourcore extended TB (eTB), 10-to 20-core saturation TB (sTB) including cores from sectors adjacent to the target, and 14 core ipsilateral TB (iTB) were compared to combined TB+SB. ResultsCancer was detected in 345 men and Gleason score 7-10 cancer in 211 men. TB alone detected 67%, eTB 76%, sTB 91% and iTB 91% of these Gleason score 7-10 cancers. In the subgroup of 33 men (7% of cohort) with an anterior >0.5 mL highly suspicious MRI lesion and a prostate volume ≤45 mL, four-core eTB detected 31 of 32 cancers (97%) and all 26 Gleason score 7-10 cancers.Conclusion sTB detected Gleason score 7-10 cancer in 25% more of the men than a two-core TB approach, and in almost as many men (91%) as the 20-26-core combined TB+SB, while needing only 10-20 cores. A four-core extended TB may suffice for large, highly suspicious anterior lesions in small or slightly enlarged prostates.

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Section: Discussionmentioning

confidence: 99%

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

et al. 2019

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“…Furthermore, transrectal biopsies after brachytherapy and after S‐HIFU increase the risk of fistulae . Moreover, to evaluate the effectiveness of the treatment, systematic control biopsies could be performed using transperineal access . The recommendation to use S‐HIFU and particularly hemi‐ablation is probably premature, especially as post‐procedural biopsies were not routinely taken from every patient.…”

Section: Discussionmentioning

confidence: 99%

Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

et al. 2019

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Objectives To evaluate the oncological and functional outcomes of salvage high‐intensity focused ultrasound (S‐HIFU) for locally recurrent prostate cancer after low‐dose‐rate (LDR) brachytherapy. Patients and Methods Clinical phase II studies (2003–2015) included 50 consecutive patients with post‐brachytherapy local recurrence treated by S‐HIFU. S‐HIFU was performed with post‐external beam radiotherapy (EBRT) parameters and, since 2008, with specific post‐brachytherapy parameters. Treatments were whole‐gland ablation and, since 2009, hemi‐ablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure‐free survival, progression‐free survival (PFS), overall survival (OS), cancer‐specific survival (CSS), and metastasis‐free survival (MFS) rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan–Meier analysis estimated oncological outcomes. Results In all, 13 patients were treated with post‐EBRT parameters, 37 with post‐brachytherapy parameters, 35 with whole‐gland treatment, and 15 with hemi‐ablation. The median follow‐up was 4.6 years. After S‐HIFU, the median prostate‐specific antigen level was 0.3 ng/mL. At 6 years, treatment failure‐free survival, PFS, OS, CSS, and MFS rates were 41%, 45%, 93%, 98%, and 80%, respectively. Post‐brachytherapy compared with post‐EBRT parameters reduced Grade 2–3 incontinence (34% vs 62%, P = 0.015). Incontinence, bladder outlet obstruction and Grade ≥III complications were significantly reduced with hemi‐ablation compared with whole‐gland treatment (14% vs 54%, P < 0.001; 13% vs 46%, P = 0.03; 13% vs 63%, P = 0.001; respectively). Before S‐HIFU, 25 patients had a five‐item version of the International Index of Erectile Function score of ≥17, which was maintained in 48% at 12 months. Conclusion S‐HIFU for locally recurrent prostate cancer after LDR brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post‐brachytherapy parameters and hemi‐ablation improve the safety of the treatment.

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“…In TP biopsy, the needle goes through the skin between the testicles and perineum. Transperineal approach results in lower risk of sepsis and usually requires general anaesthesia [34]. There are two possible approaches of transperineal biopsy: Template and targeted [32].…”

Section: Diagnosis Of Prostate Cancermentioning

confidence: 99%

Previous, Current, and Future Pharmacotherapy and Diagnosis of Prostate Cancer—A Comprehensive Review

et al. 2019

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Prostate cancer (PCa) is one of the most common cancers in men that usually develops slowly. Since diagnostic methods improved in the last decade and are highly precise, more cancers are diagnosed at an early stage. Active surveillance or watchful waiting are appealing approaches for men diagnosed with low-risk prostate cancer, and they are an antidote to the overtreatment problem and unnecessary biopsies. However, treatment depends on individual circumstances of a patient. Older hormonal therapies based on first generation antiandrogens and steroids were widely used in metastatic castration-resistant prostate cancer (mCRPC) patients prior to the implementation of docetaxel. Nowadays, accordingly to randomized clinical trials, abiraterone, enzalutamide, apalutamide. and docetaxel became first line agents administrated in the treatment of mCRPC. Furthermore, radium-223 is an optional therapy for bone-only metastasis patients. Sipuleucel-T demonstrated an overall survival benefit. However, other novel immunotherapeutics showed limitations in monotherapy. Possible combinations of new vaccines or immune checkpoint blockers with enzalutamide, abiraterone, radium-223, or docetaxel are the subject of ongoing rivalry regarding optimal therapy of prostate cancer.

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Transperineal prostate biopsy – tips for analgesia

Cited by 25 publications

References 5 publications

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

Previous, Current, and Future Pharmacotherapy and Diagnosis of Prostate Cancer—A Comprehensive Review

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