To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. Patients and methodsObservational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint TM TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). ResultsSome 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. ConclusionOur data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.

even large renal stones successfully with minimal access. This should be evaluated in future prospective trials. Based on my more than 40 years' experience with percutaneous stone removal and thorough knowledge of the changes that were introduced, I think it can justifiably be stated that the SMP technique represents the most significant progress in this field, and it will likely become the dominant method for percutaneous stone management in future.

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to detect prostate cancer (PCa) due to targeting error, inadequate sampling, or did the radiologist overcall the MRI lesion as positive? This perplexing situation leads to clinical uncertainty as to whether repeating another MR/US fusion biopsy session would be beneficial. In this study, we sought to determine whether ConfirmMDxÒ, a validated DNA methylation field effect assay, would be clinically useful if applied to TB þ SB cores with benign pathology.METHODS: In a retrospectively maintained database, we identified 142 consecutive patients who underwent MR/US fusion TB þ SB for PIRADS !3 following at least one negative SB session. Multiparametric MRI was performed using a 3-Tesla scanner and scored using PI-RADS Version 2. Among the 142 patients who underwent biopsy, 65 patients had benign pathology and were offered subsequent ConfirmMDxÒ testing of the benign TB þ SB cores. ConfirmMDxÒ was performed in a total 44 patients and alterations in GSTP1, APC, and RASSF1 correlated with abnormal regions of interest (ROI) on MRI based on corresponding sextant location.RESULTS: Among 44 patients who underwent ConfirmMDxÒ, 18/44 (40.9%) exhibited DNA hypermethylation of either GSTP1, APC, or RASSF1, while 6/44 (13.6%) exhibited hypermethylation of least two genes. DNA hypermethylation of GSTP1, APC, or RASSF1 within and outside the ROI was observed in 7/44 (15.9%) and 14/44 (31.8%) of patients, respectively. There was no correlation between PIRADS score and hypermethylation status (p > 0.05).CONCLUSIONS: Given that DNA hypermethylation of GSTP1, APC, and RASSF1 was uncommon in the benign tissue sampled from MRI-positive regions, repeating a TB will likely have low yield for detecting clinically significant PCa. In the future, sextant sampling of regions with field effects may be a more effective means of detecting occult PCa in this specific population of patients.

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