Improving the safety and tolerability of local anaesthetic outpatient transperineal prostate biopsies: A pilot study of the CAMbridge PROstate Biopsy (CAMPROBE) method

Thurtle, David; Starling, Lorraine; Leonard, Kelly; Stone, Thomas E.; Gnanapragasam, V.J.

doi:10.1177/2051415818762683

Cited by 27 publications

(27 citation statements)

References 24 publications

(35 reference statements)

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“…This may be attributable to the anxiety of having the procedure in a day surgery theatre setting, where there are more stages of preoperative checking and monitoring compared to an outpatient clinic, increasing the perceived invasiveness of the procedure in the day surgery environment. The CAMbridge PROstate Biopsy (CAMPROBE) study reported good tolerability with 1% lignocaine used as the LA; however, only a median of 11 biopsies were taken compared to an average of 24 cores in our present series . Smith et al.…”

Section: Discussionmentioning

confidence: 64%

“…Other freehand biopsy approaches reported, either use a coaxial needle placed into the perineum or the biopsy gun needle itself is visualised within the perineum. These techniques, and the recent reports of the CAMPROBE device, an elegant modification of a co‐axial needle, that facilitates ‘freehand’ biopsy utilise a ‘fan technique’, which may still under sample the anterior apical prostate, especially in large glands . Freehand needle LA TP techniques are described as being technically challenging and have a steep learning curve .…”

Section: Discussionmentioning

confidence: 99%

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Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting

et al. 2019

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Objectives To evaluate the histopathological outcomes, morbidity and tolerability of freehand transperineal (TP) prostate biopsies using the PrecisionPoint™ access system (Perineologic, Cumberland, MD, USA) under local anaesthetic (LA) in the day surgery and outpatient environments, as systematic and targeted biopsies can be taken with the potential for reduced morbidity, particularly sepsis. Patients and Methods In all, 176 patients underwent freehand TP prostate biopsies from May 2016 to November 2017. The procedure was carried out either under LA alone or with the addition of sedation. Magnetic resonance imaging (MRI) scans were reported using the Prostate Imaging‐Reporting and Data System (PI‐RADS), version 2. Tolerability was assessed using a visual analogue scale pain score for each procedural stage. Histopathological outcomes and complications were recorded. Results The mean (range) age was 65 (36–83) years, median (range) prostate‐specific antigen level was 7.9 (0.7–1374) ng/mL, and the mean (range) prostate volume 45 (15–157) mL. Biopsies were taken under LA alone (160 patients, 90%) or under LA with sedation (16, 9%). The main indication for biopsy was primary diagnosis (88.6%). In all, 91 (52%) patients underwent systematic TP biopsies (mean 24.2 cores). Cognitive MRI‐targeted biopsies alone were performed in 45 patients (26%; mean 6.8 cores), and 40 (23%) had both systematic and target biopsies (mean 27.9 cores). Of the 75 patients who had primary systematic biopsies alone, 46 (61%) were positive, and 28/46 (60.9%) were diagnosed with clinically significant disease (Gleason ≥3+4). VAS pain scores were greatest during LA administration. There were five complications (2.8%, Clavien–Dindo Grade I/II). No patients developed urosepsis. Conclusions Freehand TP biopsies using the PrecisionPoint access system is a safe, tolerable and effective method for systematic and targeted biopsies under LA in the outpatient setting. It has replaced transrectal biopsies in our centre and has potential to transform practice.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting

et al. 2019

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“…The requirement for sedation or GA relates to patient tolerability due to the exaggerated positioning of the patient required to place a stepper and grid, as well as the need for a skin puncture per biopsy taken. Advancements have recently been made in device technologies to allow for TPBx to be performed under LA using the PPTAS and other devices 11,13–15 . This method not only benefits the patient by eliminating the risk of undergoing GA but also has a potential economic impact on the healthcare system given the reduced resources required.…”

Section: Discussionmentioning

confidence: 99%

Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

et al. 2021

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Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.

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“…Of note, the Cambridge Prostate Biopsy (CAMPROBE), developed by Thurtle et al. [ 70 ], has shown to be effective in administering local anaesthesia with reduced pain and 87% preference over TRUS biopsy. Technically, this is similar to the transrectal biopsy; the MRI targeted transperineal biopsy can be either cognitive guided, MRI software fusion biopsy, or in-bore MRI transperineal biopsy.…”

Section: Mri-tbmentioning

confidence: 99%

Magnetic resonance imaging-guided prostate biopsy—A review of literature

Bhat

Samavedi

Moschovas

et al. 2021

Asian Journal of Urology

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Objective Multiparametric magnetic resonance imaging (MP-MRI) helps to identify lesion of prostate with reasonable accuracy. We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy. Materials and methods A literature search was performed for “multiparametric MRI”, “MRI fusion biopsy”, “MRI guided biopsy”, “prostate biopsy”, “MRI cognitive biopsy”, “MRI fusion biopsy systems”, “prostate biopsy” and “cost analysis”. The search operation was performed using the operator “OR” and “AND” with the above key words. All relevant systematic reviews, original articles, case series, and case reports were selected for this review. Results The sensitivity of MRI targeted biopsy (MRI-TB) is between 91%–93%, and the specificity is between 36%–41% in various studies. It also has a high negative predictive value (NPV) of 89%–92% and a positive predictive value (PPV) of 51%–52%. The yield of MRI fusion biopsy (MRI-FB) is similar, if not superior to MR cognitive biopsy. In-bore MRI-TB had better detection rates compared to MR cognitive biopsy, but were similar to MR fusion biopsy. Conclusions The use of MRI guidance in prostate biopsy is inevitable, subject to availability, cost, and experience. Any one of the three modalities ( i.e. MRI cognitive, MRI fusion and MRI in-bore approach) can be used. MRI-FB has a fine balance with regards to accuracy, practicality and affordability.

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Improving the safety and tolerability of local anaesthetic outpatient transperineal prostate biopsies: A pilot study of the CAMbridge PROstate Biopsy (CAMPROBE) method

Cited by 27 publications

References 24 publications

Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting

Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting

Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

Magnetic resonance imaging-guided prostate biopsy—A review of literature

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