Presentation Authors: Angus Campbell*, Altan Omer, Oxford, United Kingdom, Luke Stroman, London, United Kingdom, Aaron Leiblich, Yiannis Philippou, Omar Musbahi, Nithesh Ranasinha, Richard J Bryant, Oxford, United Kingdom, Rick Popert, London, United Kingdom, Freddie Hamdy, Simon Brewster, Richard Bell, Oxford, United Kingdom, Simon Van Rij, Aukland, New Zealand, Wayne Lam, Lung Fu Shan, Hong Kong, Alastair D Lamb, Oxford, United Kingdom
Introduction: With infection rates and quinolone resistance increasing, we require straightforward alternatives to transrectal biopsy. TP biopsy has historically been more expensive to deliver and dependent on GA and operating theatre facilities. We investigated the use of a TP access system, Precision Point, under LA in the outpatient setting, and assessed sampling of the prostate and tolerability.
Methods: Case selection: Patients with TRUSBx histological discordance, active surveillance and cancer screening. _x000D_
Antibiotics: Patients received pre-procedure antibiotics in accordance with local hospital guidelines. Equipment: PrecisionPointâ„¢ transperineal access system. Triplane or biplane transrectal ultrasound transducer in biplane mode. LA technique: Subcutaneous perineal nerve block + prostatic apex block + periprostatic nerve block (PPNB). No sedation.Biopsy protocol: Free hand transperineal biopsy using Ginsburg protocol +/- Cognitive MRI supported targeted biopsies.Data: Prospectively collected.
Results: Characteristics:116 patients underwent LATP Biopsy from 4 institutions. 21 (18%) were performed for active surveillance and cancer was detected in 15 (71.4%) patients.69 (59%) were performed for cancer screening.26 (22.4%)were re-classification biopsies. _x000D_
Median age was 65.5(48-79)years, median PSA 7.5 (2.6-43)ng/ml; median prostate volume 121.6(24-217)cc. and median number of biopsies was 24 (16-32)._x000D_
Complications:There was no urinary retention or procedures abandoned due to pain. 3 patients experienced vaso-vagal episodes. 1 patient developed haematoma. 1 patient developed epididymo-orchitis within 2 weeks and was the only re-admission._x000D_
Oncologic outcomes:Prostate cancer was found in 72/116 (62%) patients of which 57 (49%) had clinically significant prostate cancer.Patient reported outcomes:4 out of 34 men (11.8%) said a repeat biopsy would be a significant problem. 11 out of 34 (32.4%) said it would be no problem at all.
Conclusions: LATP biopsy using a Transperineal Access System is safe and well tolerated. The procedure is more flexible and efficient than traditional stepper systems. We encourage other centres to adopt this technique. We also anticipate use of MRIâ€“US fusion using this technique in the outpatient setting.