Education / Lap & Robotics / Surgical Innovations
Introduction & Objective :
Prostate cancer is the most common cancer in men, accounting for an estimated 164,000 new cases in 2018, and over 29,000 deaths. Prostate cancer has traditionally been diagnosed with prostate needle biopsy using a trans-rectal approach. However, prostate needle biopsy using a trans-perineal approach has become more prevalent because of its improved ability to sample the anterior and peripheral zones of the prostate, and decreased risk of infection. In this study we describe the experience of a single academic center during the implementation of prostate needle biopsy via the trans-perineal approach.
This retrospective study included the first 114 patients who underwent trans-perineal prostate needle biopsy between January 2017 and December 2017 with three attending urologists in a teaching environment. Cystoscopy was performed at the time of each biopsy, and conducted in an outpatient surgical center under general anesthesia with one dose of perioperative antibiotics. Follow-up was conducted within two weeks.
The mean patient age was 63.5 years, and self-reported ethnicity was 88% Caucasian, 11% African American, and 1% Hispanic. The most common reason for biopsy was elevated prostate specific antigen (71%), active surveillance (15%), and abnormal prostate exam (14%). The median PSA was 7.5. The cancer detection rate was 66.9% overall, but was 71% for first time biopsies, and 40% in those with a previously negative biopsy. The mean time to complete each biopsy during the first 3 months was 33.7 minutes, whereas the mean time to complete each biopsy during the last 3 months was 24.8 minutes (p=0.001). The cancer detection rate during the 1st v. 4thquarter was 58.3% v. 76.3%, respectively, (p<0.001). The most common side effects were mild, self-limiting hematuria/hematospermia (8.8%), urinary retention (2.6%), perineal pain (3.5%), fever requiring admission (0.9%).
In this study we present the outcomes and implementation of the trans-perineal approach of prostate needle biopsy. We show evidence that this approach is safe, can be implemented quickly, and provides patients with an acceptable side-effect risk profile with excellent cancer detection rates.