Mp67-18 Transperineal Sector Biopsy as a First-Line Biopsy Strategy: A Multi-Institutional Analysis of 409 Patients

Eldred‐Evans, David; Vyas, Lona; Kinsella, Netty; Acher, Peter; Popert, Rick

doi:10.1016/j.juro.2014.02.2085

Cited by 7 publications

(11 citation statements)

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“…In patients without a targetable lesion on MRI who underwent primary systematic biopsies the cancer detection rate was 61%, of whom 61% had clinically significant disease. This outcome is comparable to other reported primary TP biopsy series using both template mapping biopsies or the Ginsburg protocol . TRUS‐guided biopsies have reported detection rates of 40–44% in cohorts of similar risk to our present study without pre‐biopsy MRI.…”

Section: Discussionsupporting

confidence: 90%

“…None of our patients developed urosepsis, which is a recognised and costly complication of TRUS‐guided biopsies . A mean of 24 cores were taken for a systematic TP biopsy, and 28 cores for a combination of targeted and systematic biopsy, thus comparable to other TP and TP with MRI‐fusion biopsy series . Using PrecisionPoint, equivalent sampling was achieved with two punctures under LA, rather than multiple perineal punctures under GA with a template.…”

Section: Discussionmentioning

confidence: 90%

“…TP biopsy is associated with post‐procedural urinary retention and other complications because of the greater number of cores that are taken compared to TRUS‐guided biopsy and the use of GA . Historically, this was the case with TP template‐guided mapping biopsies whereby 1–2 cores/mL were taken using a 5 mm grid, with probable oversampling of the transition zone causing swelling; this was not our finding with systematic Ginsburg sectoral biopsies that are preferentially directed at the peripheral zone . Despite taking 24–28 cores under LA, patients who developed post‐procedural urinary retention occurred early in our learning curve, with both patients having sedation and LA.…”

Section: Discussionmentioning

confidence: 96%

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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: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 96%

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

et al. 2019

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“…All patients included completed the biopsy process. Perineal puncture is a better choice for sampling of the anterior and apical regions, especially when the prostate is large [21]. However, combination of both tans-rectal and perineal puncture could not improve cancer detection rate compared to tansrectal solely [22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of local infiltration anesthesia and mucous surface anesthesia in trans-rectal ultrasound-guided prostate biopsy

Lin¹,

Zang²,

Lu³

et al. 2019

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Background: To compare the efficacy and safety of local infiltration anesthesia and mucous surface anesthesia in patients undergoing trans-rectal ultrasound-guided (TRUS guided) prostate biopsy. Methods: Patients with suspected prostate cancer undergoing TRUS guided prostate biopsy were randomly divided into two groups between January 2018 and March 2019. Local infiltration anesthesia was performed in the experimental group with lidocaine; while the control group was treated with mucous surface anesthesia. We collected baseline characteristics. Residual urine volume was measured twice: before biopsy, the first micturition after biopsy. Associated complications, positive rate of biopsy, visual analog pain scale (VAS) and Gleason score were recorded. Results: The study included 78 patients. The pain score of experimental group was significantly lower than the control group. Experimental group had lower rate of urinary retention and catheterization. Both groups had similar positive rate of biopsy, residual urine volume, Gleason score, fever and so on. Conclusion: Comparing with mucous surface anesthesia, local infiltration anesthesia relieved the pain better in patients undergoing TRUS guided prostate biopsy. It was more effective and safer. Trial registration: Chinese Clinical Trial Registry, Trial registration number (TRN): ChiCTR1800016424, Date of registration: 01/06/ 2018.

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“…Differences in diagnostic accuracy, however, remain unclear. Emerging evidence suggests that TP biopsy identifies cancers in the anterior prostate at higher rates than was previously expected, potentially due to the different biopsy trajectory in a TP compared to transrectal approach [8][9][10].…”

Section: Introductionmentioning

confidence: 92%

Detection of clinically significant cancer in the anterior prostate by transperineal biopsy

et al. 2020

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Objective To determine the incidence of clinically significant prostate cancer (csPCa) detected exclusively in the anterior prostate using transperineal prostate biopsy. Patients and Methods Histopathology results of all patients who underwent transperineal prostate biopsy between February 2016 and March 2018 at a single institution were assessed for distribution of cancer within the prostate. Patients with cancer found exclusively in the anterior prostate were then compared to those with any cancer found in the posterior or lateral prostate with International Society of Urological Pathology Grade Group 2–5 cancers being considered csPCa. Results A total of 508 patients were included. Overall, 12.0% of the cohort had csPCa detected only in anterior biopsies. When stratified by prostate‐specific antigen (PSA) level, 6.6% of men with a PSA level of 4.1–10.0 ng/mL and 8.2% of men with a PSA level of >10.0 ng/mL had csPCa detected in the anterior prostate alone. Conclusion Transperineal biopsy has the ability to diagnose anteriorly located csPCa that would potentially have been missed by the transrectal approach.

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Mp67-18 Transperineal Sector Biopsy as a First-Line Biopsy Strategy: A Multi-Institutional Analysis of 409 Patients

Cited by 7 publications

References 0 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

Comparison of local infiltration anesthesia and mucous surface anesthesia in trans-rectal ultrasound-guided prostate biopsy

Detection of clinically significant cancer in the anterior prostate by transperineal biopsy

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