Transperineal Sector Prostate Biopsies: A Local Anesthetic Outpatient Technique

Smith, J.; Popert, Rick; Nuttall, Martin; Vyas, Lona; Kinsella, Netty; Cahill, Declan

doi:10.1016/j.urology.2014.02.008

Cited by 39 publications

(28 citation statements)

References 19 publications

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“…Reducing the biopsy density might have a positive impact on this, and indeed a recent series has shown the feasibility of performing an alternative TTPM strategy under local anaesthesia [17]. However, in light of our findings, the reduced cost should be balanced against the reduced diagnostic performance and its clinical implications.…”

Section: Discussionmentioning

confidence: 71%

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

et al. 2015

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ObjectivesTo determine whether modified transperineal template prostate mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value equal to full 5mm TTPM. Materials and MethodsRetrospective analysis of an institutional registry including treatment-naïve men undergoing 5mm TTPM analysed in 20 zones fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5mm TTPM.Strategy 1 did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was employed to calculate reliable estimates of sensitivity and negative predictive value of these three strategies with respect to detection of clinically significant disease (maximum cancer core length >/= 4mm and/or Gleason score >/= 3+4).Results 391 men with median age 62 years (IQR 58-67) were included. Median PSA and PSA density were 6.9 ng/ml (IQR 4.8-10) and 0.17 (IQR 0.12-0.25), respectively. A median of 6 cores (IQR 2-9) out of 48 taken per man (IQR 33-63) were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low, intermediate and high risk disease was identified in 78 (20%), 80 (21%) and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% (95% CI 73-84%), 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The negative predictive values of the three strategies was at 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively. ConclusionAltering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM to rule out clinically significant disease. This should be considered when modified TTPM strategies are performed to select men for tissue-preserving approaches, and when modified TTPM are employed to validate new diagnostic tests.

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Section: Discussionmentioning

confidence: 71%

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

et al. 2015

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“…Smith et al. , evaluated the VAS pain scores for LA template stepper‐based biopsies in a small selected cohort of patients. The pain scores reported (mean [ sd] 3.08 [1.64], 3.29 [1.13], and 2.88 [1.28]) for probe insertion, LA administration, and biopsies, respectively, were similar to our present outpatient cohort (1.05, 3.75, and 2.8, respectively; Table ).…”

Section: Discussionmentioning

confidence: 99%

“…The pain scores reported (mean [ sd] 3.08 [1.64], 3.29 [1.13], and 2.88 [1.28]) for probe insertion, LA administration, and biopsies, respectively, were similar to our present outpatient cohort (1.05, 3.75, and 2.8, respectively; Table ). The LA injection is the most painful part of the procedure and appears to be universally reported in both TRUS‐guided and LA TP template methods . Meyer et al.…”

Section: Discussionmentioning

confidence: 99%

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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“…Pain management, on the other hand, is more challenging with TP biopsy, since it has been reported to be more painful [37]. At our institution, TP biopsy is only performed in general anesthesia and therefore might not be suitable for outpatient procedures, although there are few working groups reporting the possibility to obtain it under local anesthesia [38]. …”

Section: Discussionmentioning

confidence: 99%

Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

Tewes

Peters

Tiemeyer

et al. 2017

BioMed Research International

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Purpose To evaluate transrectal (TR) and transperineal (TP) approaches for MRI/ultrasound (MRI/US) fusion-guided biopsy to detect prostate cancer (PCa). Materials and Methods 154 men underwent multiparametric MRI and MRI/US fusion-guided biopsy between July 2012 and October 2016. 79/154 patients were biopsied with a TR approach and 75/154 with a TP approach. MRI was retrospectively analyzed according to PI-RADS version 2. PI-RADS scores were compared with histopathological results. Descriptive statistics, accuracy, and negative and positive predictive values were calculated. Histopathological results of first, second, and third MRI targeted biopsy cores were compared to evaluate the impact of one verus multiple targeted cores. Results Detection rates of PCa were 39% for TR biopsy and 75% for TP biopsy. Sensitivity/specificity for tumor detection with PI-RADS ≥ 4 were 81/69% for TR biopsy and 86/84% for TP biopsy. In 31% for TR biopsy and 19% for TP biopsy, PCa was found in the second or third MRI targeted biopsy core only. Conclusion MRI/US fusion-guided biopsy may be conducted with the TR as well as the TP approach with high accuracy, giving more flexibility for diagnosis and the option for focal treatment of PCa.

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Transperineal Sector Prostate Biopsies: A Local Anesthetic Outpatient Technique

Cited by 39 publications

References 19 publications

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

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

Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

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