Category: New Technology: Miscellaneous

MP22-5 - Outcomes of local anaesthetic freehand transperineal biopsies in the outpatient setting: How does this compare to conventional biopsy methods?

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Traditionally, prostate biopsies have been performed via the transrectal (TRUS) approach. The PrecisionPoint™ transperineal access system enables both standard systematic template and targeted freehand transperineal (TP) prostate biopsy, under local anesthetic (LA) in the outpatient department (OPD) setting.

To evaluate the use of freehand TP prostate biopsies in diagnosis of clinically significant prostate cancer. To assess the safety, tolerability and cancer diagnosis potential of this method.


Methods :

All 176 patients who underwent freehand TP prostate biopsies using the PrecisionPoint™ system from April 2016 to November 2017 were included. 16(9%) were carried out under LA+Sedation and 160(91%) under LA alone. Outcomes were analysed and compared with a historical prospectively collected database of TRUS biopsy from the same institution and operators.


Results :

Mean age was 65(36-83)years, median PSA 7.9(0.7-1374)ng/ml and mean prostate volume 45(15-157)cc, similar to the TRUS group. The main indication for biopsy was for primary diagnosis (88.6%). 71 (40%) cases took place in the OPD and 105 (60%) in the day surgery setting, due to logistical arrangements and initial learning curve.


 


91 (52%) patients underwent systematic TP biopsies (mean 24.2 cores) under LA. Cognitively MRI targeted biopsies were performed in 45 (26%) patients (mean 6.8 cores). A further 40 (23%) had standard TP systematic + target biopsies of an MRI lesion (mean 27.9 cores in total). Of the 75 cases who had primary systematic biopsies alone, 46 (61%) were positive, similar to TRUS (55.8%, 43/77, P=0.50). 28/46 (60.9%) were diagnosed with clinically significant disease (Gleason >3+4), TRUS group 25/43 (58.1%, P=0.80).


 


Of patients who had a target only biopsy, 93% (38/41) were malignant. 33/38 (87%) found clinically significant disease. 89% (35/40) of the target+systematic biopsies were malignant. The target lesion was positive in 30/35 (85.7%). 29/35 (80.6%) had clinically significant disease. In 2/35 (5.7%), the tumour would have been completely missed if a target biopsy alone was done only based on the MRI reported lesion.


 


Pain scores of the LA TP group were not significantly different to TRUS at any procedural stage. There were 5 complications (2.8%, Clavien-Dindo I/II). No patients developed urinary sepsis.


Conclusions :

Transperineal systematic and targeted prostate biopsies can be performed safely under LA using the PrecisionPoint™ Transperineal Access system. This method is well tolerated and cancer pickup rates are equivalent to conventional biopsy methods. This method has now replaced the transrectal approach in the outpatient setting in our department.

Francesca E C. Kum

Urology Registrar
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Francesca Kum, ST3 Urology Registrar in London, currently working at St George's Hospital

Oussama Elhage

Consultant Urological Surgeon
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Jed Maliyil

Medical Student
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Kathie Wong

Urology Registrar
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Nicholas Faure Walker

Urology Registrar
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Meghana Kulkarni

Urology Registrar
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Benjamin Challacombe

Consultant Urological Surgeon
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Paul Cathcart

Consultant Urological Surgeon
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Rick Popert

Consultant Urological Surgeon
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Benjamin Namdarian

Consultant Urologist
Guy's and St Thomas Foundation Trust
London, England, United Kingdom