Local Anaesthetic Transperineal Prostate (LATP) biopsy using a probe-mounted transperineal access system: A multi-centre prospective outcome analysis.
Lopez JF., Campbell A., Omer A., Stroman L., Bondad J., Austin T., Reeves T., Phelan C., Leiblich A., Philippou Y., Lovegrove C., Ranasinha N., Bryant RJ., Leslie T., Hamdy F., Brewster S., Bell R., Popert R., Hodgson D., Elsaghir M., Eddy B., Bolomytis S., Persad R., Reddy U., Foley C., van Rij S., Lam W., Lamb AD.
OBJECTIVES: To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal access device, and report initial prostate cancer (PCa) detection, infection rates and tolerability. PATIENTS AND METHODS: Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: 1) first biopsy in suspected PCa, 2) confirmatory biopsies for active surveillance and 3) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive MRI targeted biopsies when needed using the Precision PointTM transperineal access device. Procedure related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient reported outcomes (PROMs). RESULTS: Some 1218 patients underwent LATP biopsies at ten centres: 55%, 24% and 21% for each of the three settings respectively. Any-grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients with a 56% response rate (n=234). In these men, pain during the biopsy was described as either "not at all" or "a little" painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be "not a problem" and in contrast 8.1% would consider it a "major problem". Most of the patients (81%) described the biopsy as a "minor or moderate procedure tolerable under local anaesthesia", while 5.6% perceived it as a "major procedure that requires general anaesthesia". CONCLUSION: Our data suggest that LATP biopsy using a transperineal access system mounted to the ultrasound probe achieves excellent PCa detection with very-low sepsis rate and is safe and well tolerated. We believe a randomized controlled trial comparing LATP with TRUS to investigate the relative trade-offs between each biopsy technique would be helpful.