Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System

Tzeng, Michael; Basourakos, Spyridon P.; Patel, Hiten D.; Allaway, Matthew; Hu, Jim C.; Gorin, Michael A.

doi:10.1002/bco2.178

Cited by 4 publications

(5 citation statements)

References 44 publications

(129 reference statements)

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“…Nurses were trained using the PrecisionPoint Transperineal Access System developed by Perineologic, Cumberland, MD, USA 11 . This method was chosen due to its ease of use and being well documented in peer‐reviewed literature as a safe, tolerable and effective method for TP biopsy 12–14 …”

Section: Methodsmentioning

confidence: 99%

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Developing and centralising a nurse‐led local anaesthetic transperineal biopsy service during COVID

et al. 2023

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IntroductionTransperineal (TP) biopsy has recently replaced the transrectal ultrasound (TRUS) approach as the ideal method of biopsy in the United Kingdom with growing trends to adopt. To minimise transmission of COVID‐19 during the first wave of the pandemic, the British Association of Urological Surgeons Section of Oncology issued guidelines reducing general anaesthesia (GA) procedures and initiate COVID‐secure ‘green’ site diagnostics. As a result of these guidelines and reduction in clinical diagnostics trust‐wide, we ceased all TRUS diagnostics and implemented a centralised, nurse‐led LA TP biopsy service.Materials and methodsA waiting list was developed for those awaiting prostate cancer diagnostics across the network. A COVID‐secure ‘green’ site was quickly identified with TP biopsies starting soon after. Quality improvement methodology was utilised and a run chart was used to show if changes were sustainable.ResultsSuccessful implementation and centralisation of a TP biopsy service occurred with TRUS guided biopsies ceasing across all sites on 12 May 2020. The procedures were carried out by urology advanced nurse practitioners under local anaesthesia with a select few occurring under GA. Centralising the service in a COVID‐secure manner freed up dedicated theatre sessions and personal leading to increased efficiency elsewhere. The service was robust and was maintained upon lifting of COVID restrictions.ConclusionsA centralised, nurse led LA TP biopsy service in a procedural unit was implemented successfully. The service has remained resilient upon lifting of restrictions and return to business as usual. This led to improved performance across trust by freeing up valuable resources and staff to undertake more duties. The service remains highly valued trust‐wide.

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Section: Methodsmentioning

confidence: 99%

“…11 This method was chosen due to its ease of use and being well documented in peer‐reviewed literature as a safe, tolerable and effective method for TP biopsy. 12 , 13 , 14 …”

Section: Methodsmentioning

confidence: 99%

Developing and centralising a nurse‐led local anaesthetic transperineal biopsy service during COVID

et al. 2023

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“…The TP approach offers reduced risk of infection, as well as improved anterior and apical sampling, but is limited by the requirement of general anesthesia [67]. The introduction of the freehand technique (e.g., PrecisionPoint Transperineal Access System, Perineologic) paired with effective local anesthesia has decreased the procedural time allowed for office-based practice, thus rapidly increasing adaptation of the TP approach [68,69].…”

Section: Tp Vs Tr Approachmentioning

confidence: 99%

MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed

Lang,

McClure,

Margolis

2024

Cancers

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The use of MRI–ultrasound image fusion targeted biopsy of the prostate in the face of an elevated serum PSA is now recommended by multiple societies, and results in improved detection of clinically significant cancer and, potentially, decreased detection of indolent disease. This combines the excellent sensitivity of MRI for clinically significant prostate cancer and the real-time biopsy guidance and confirmation of ultrasound. Both transperineal and transrectal approaches can be implemented using cognitive fusion, mechanical fusion with an articulated arm and electromagnetic registration, or pure software registration. The performance has been shown comparable to in-bore MRI biopsy performance. However, a number of factors influence the performance of this technique, including the quality and interpretation of the MRI, the approach used for biopsy, and experience of the practitioner, with most studies showing comparable performance of MRI–ultrasound fusion to in-bore targeted biopsy. Future improvements including artificial intelligence promise to refine the performance of all approaches.

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“…The delayed transition from a transrectal to a transperineal approach may be attributed to the prevailing assumptions that TPBx necessitates either general or regional anaesthesia and may lead to elevated rates of non-infectious complications. However, recent studies report that TPBx under local anaesthesia (LA) are associated with a median visual analogue scale (VAS) pain score between 2 and 4, indicating that TPBx is a well-tolerated outpatient procedure [3,12]. Although the rate of acute urinary retention (AUR) ranges between 0.22% and 24%, the highest rates are predominantly observed after saturation biopsy under general anaesthesia [3,5,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…However, recent studies report that TPBx under local anaesthesia (LA) are associated with a median visual analogue scale (VAS) pain score between 2 and 4, indicating that TPBx is a well-tolerated outpatient procedure [3,12]. Although the rate of acute urinary retention (AUR) ranges between 0.22% and 24%, the highest rates are predominantly observed after saturation biopsy under general anaesthesia [3,5,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Non‐infectious adverse events of transperineal prostate biopsies performed under local anaesthesia

Jacewicz,

Rud,

Lauritzen

et al. 2024

BJU International

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ObjectiveTo report non‐infectious adverse events associated with transperineal prostate biopsy (TPBx) performed under local anaesthesia (LA) in an outpatient setting.Patients and methodsThis study reports secondary outcomes from the Norwegian arm of the prospective NORAPP study (ClinicalTrials.gov identifier NCT04146142) and included all patients referred for prostate biopsy from November 2019 to February 2021. Transperineal magnetic resonance imaging‐transrectal ultrasonography fusion TPBx were taken using 40 mL 1% lidocaine with 4 mL of 8.4% sodium bicarbonate placed in the perineal skin, under the prostatic apex, in the m. levator ani bilaterally, and along the path of the needle. Follow‐up using patient‐reported questionnaires was done immediately after TPBx, and after 2 weeks and 2 months. Pain was reported using a visual analogue scale (VAS) during placement of the LA, and during and after TPBx. Haematuria and acute urinary retention (AUR) rates were recorded.ResultsWe included 402 patients, and the response rate was 99.8% (401/402). The median (interquartile range [IQR]) age was 69 (63–74) years, the prostate volume was 40 (27–58) mL, the prostate‐specific antigen level was 7.0 (4.5–11) ng/mL, and the number of biopsy cores taken was 8 (6–10). The median (IQR) VAS pain score was 1 (1–2) during placement of LA, 1 (0–2) during TPBx, and 0 (0–0) after TPBx. Haematuria and AUR rates were 64% (95% confidence interval [CI] 60–69%) and 0.5% (95% CI 0.1–1.8%), respectively. No patients were hospitalised or required after the TPBx surgical intervention.ConclusionTransperineal prostate biopsies can be performed under LA with limited discomfort to the patient and few post‐TPBx adverse events.

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Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System

Cited by 4 publications

References 44 publications

Developing and centralising a nurse‐led local anaesthetic transperineal biopsy service during COVID

Developing and centralising a nurse‐led local anaesthetic transperineal biopsy service during COVID

MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed

Non‐infectious adverse events of transperineal prostate biopsies performed under local anaesthesia

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