Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution

Roberts, Matthew J.; Macdonald, Alastair; Ranasinghe, Sachinka; Bennett, Harrison Y.; Teloken, Patrick; Harris, Patrick N A; Paterson, David L.; Coughlin, Geoff; Dunglison, Nigel; Esler, Rachel; Gardiner, Robert A.; Elliott, Thomas M.; Gordon, Louisa G.; Yaxley, John

doi:10.1038/s41391-020-0263-x

Cited by 28 publications

(17 citation statements)

References 45 publications

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“…In addition, a significant difference in upgrading rates of anterior and apical tumours was also demonstrated. This is in the context of increasing evidence for benefits of TP biopsies, where there may be lower infection complications, hospital readmissions, and long-term healthcare costs [14].…”

Section: Discussionmentioning

confidence: 99%

Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients

Al-Shawi

Howard

et al. 2021

Int Urol Nephrol

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Purpose Accurate assessment of Gleason grade is essential to guiding prostate cancer management. Not all healthcare systems have universal access to prostate MRI. We investigated whether transperineal (TP) prostate biopsies provide more accurate Gleason grading than transrectal (TR) biopsies in MRI-naïve patients. Methods Consecutive patients undergoing TP and TR systematic prostate needle biopsies from 2011 to 2018 were analysed. Patients who underwent radical prostatectomy (RP) within 180 days of biopsies were included. Patients undergoing MRI prior to biopsies were excluded. Pathological concordance, incidence of Gleason upgrading, and correlation coefficients among biopsies and RP Gleason grade were compared. A sub-analysis for concordance in anterior prostate tumours was conducted. Results 262 patients were included (112 TP; 150 TR), the median age was 63 years, and median time from biopsy to RP was 68 days. Concordance with RP histology for TP was 65% compared to 49% for TR (p = 0.011). Biopsy technique predicted RP concordance independent of the number of cores. Gleason upgrading occurred following 24% of TP versus 33% of TR biopsies. In anterior and apical tumours, upgrading occurred in 19% of TP biopsies and 38% of TR biopsies (p = 0.027). Conclusion This study suggests TP approach to prostate biopsies result in improved histological grade accuracy in men whom MRI is not available, even after controlling for number of cores. TP approach also resulted in less upgrading for lesions in the anterior and apical prostate compared to TR.

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Section: Discussionmentioning

confidence: 99%

Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients

Al-Shawi

Howard

et al. 2021

Int Urol Nephrol

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“…However, the eventual shift towards TP biopsy seems to help drive overall cost down, with lower infectious‐related admissions. 28 In the United Kingdom, the TRexit initiative, 29 which comprises six London hospitals, have successfully ceased all TR biopsies and converted to a pure TP under LA biopsy service since March 2019. Our institution has also moved away from TR biopsies since October 2018 and is now exclusively performing TP biopsies.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is additional capital cost in procuring the PrecisionPoint™ Transperineal Access System. However, the eventual shift towards TP biopsy seems to help drive overall cost down, with lower infectious‐related admissions 28 . In the United Kingdom, the TRexit initiative, 29 which comprises six London hospitals, have successfully ceased all TR biopsies and converted to a pure TP under LA biopsy service since March 2019.…”

Section: Discussionmentioning

confidence: 99%

Comparing outcomes of transperineal to transrectal prostate biopsies performed under local anaesthesia

et al. 2021

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Objectives: To compare and review the outcomes of transperineal (TP) prostate biopsies with transrectal (TR) biopsies performed under local anaesthesia (LA). A review of the relevant published literature is presented.Patients and methods: We prospectively analysed 212 consecutive patients who underwent TP prostate biopsy using the PrecisionPoint™ access system under LA, at our institution from October 2018 to March 2020. We compared the morbidity and cancer detection rates using this approach with our historical cohort of 178 patients who underwent the TR biopsy method under LA. Results:The mean age of the TP biopsy group was 69 years, and median prostate specific antigen (PSA) was 13.17 ng/ml. Mean prostate volume was 45.1 ml with a median of 12 cores taken per patient. Patient demographics were similar to our TR biopsy cohort, with mean age of 68 years, median PSA of 10.76, mean prostate volume of 49.6 ml and a median of 12 cores taken per patient. The TP biopsy group had 0% sepsis rate compared with 2.2% in the TR group. Haematuria in the TP versus transrectal ultrasonography (TRUS) cohort was 0.9% versus 1.7%, respectively. The TP biopsy-naïve group had a cancer detection rate of 63.5% (127 of 200 patients), of which 84% were ≥Grade Group 2 (GG2). The TR biopsy-naïve group had cancer detection rate of 50% (86 of 172 patients), of which 87.2% was ≥GG2.Conclusion: TP prostate biopsy had less urinary infectious and septic complications compared with the TR approach. Our data suggest at least comparable diagnostic accuracy between both biopsy approaches.

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“…There has been a gradual shift in practice towards transperineal prostate (TP) biopsies as the mainstay technique for prostate biopsies [ 4 ]. TP technique has shown to be superior with a similar cancer detection rate and reduced complications compared to transrectal ultrasound—guided (TRUS) prostate biopsies [ 5 , 6 ]. It has been recommended to obtain 24–36 core systematic biopsies in the anterior, mid and posterior sectors of the peripheral zones [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The design and validation of a low-cost trans perineal (TP) prostate biopsy simulator for training: improving trainees’ confidence and cognitive targeting skills

et al. 2023

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Purpose The aim of this research was to create a novel and low-cost TP prostate biopsy simulator that has face, content and construct validity with high educational value. Methods This research developed a trans perineal prostate (TP) biopsy simulator using 3D-printed moulds and tissue-mimicking materials. Important regions (anterior, mid, and posterior zones) were coded with different colours. Ultrasound visible abnormal lesions were embedded in the prostate phantom. Expert and novice participants in TP biopsies were recruited. Essential skills were identified through the consensus of six experts. These skills were assessed through tasks performed by participants. This included the accuracy and timing of systematic and target biopsies. Immediate feedback was determined by the colour of the biopsy cores taken. A survey was distributed to evaluate its realism and educational value. Results The material cost of one simulator was £7.50. This simulator was proven to have face, content, and construct validity. There was a significant difference ( p = 0.02) in the accuracy of systematic biopsies between both experts and novices. Significant difference was also observed ( p = 0.01), in accurately identifying target lesion on ultrasound between both groups. Participants rated the overall realism of the simulator 4.57/5 (range 3–5). 100% of the experts agreed that introducing this simulator to training will be beneficial. 85.7% of the participants strongly agree that the simulator improved their confidence in TP biopsies. Conclusion There is value in integrating this proof-of-concept TP prostate biopsy simulator into training. It has highly rated educational value and has face, content, and construct validity. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-023-04387-y.

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Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution

Cited by 28 publications

References 45 publications

Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients

Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients

Comparing outcomes of transperineal to transrectal prostate biopsies performed under local anaesthesia

The design and validation of a low-cost trans perineal (TP) prostate biopsy simulator for training: improving trainees’ confidence and cognitive targeting skills

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