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Clinical Research

Feasibility of freehand MRI/US cognitive fusion transperineal biopsy of the prostate in local anaesthesia as in-office procedure—experience with 400 patients

Prostate Cancer and Prostatic Diseases volume 23, pages 429–434 (2020)Cite this article

Subjects

Abstract

Background

Transrectal (TR) ultrasound-guided prostate biopsy is one of the most commonly performed urologic procedures worldwide. The major drawback of this approach is the associated risk for infectious complications. Sepsis rates are increasing due to rising antibiotic resistance, representing a global issue. The transperineal (TP) approach for prostate biopsy has recently been adopted at many centres as an alternative to the TR biopsy, and it was shown to be associated with a lower risk for sepsis. The aim of this study was to assess safety and tolerability of TP prostate biopsy performed in local anaesthesia.

Methods

We retrospectively analysed data of patients who had undergone office-based TP prostate biopsy in local anaesthesia, performed by a single surgeon between January 2015 and May 2019. We evaluated the patients’ acceptance of the procedure by a pain score, as well as its safety and diagnostic performance.

Results

Four hundred patients were included. Median age was 66 years [range, 49–86]. Median prostate-specific antigen (PSA) concentration was 6.4 ng/ml [range, 0.3–1400], median PSA density was 0.15 ng/ml2 [range, 0–31.1] and median prostate volume was 40 ml [range, 6–150]. A total of 118 (29.5%) and 105 (26.2%) patients had orally received two and one doses of 500 mg fluoroquinolone, respectively, and 177 (44.3%) patients did not receive any antibiotic prophylaxis. No infectious complications occurred. Median pain score was 2.0 (range, 0–8). Overall cancer detection rate was 64.5% (258/400).

Conclusions

Freehand TP prostate biopsy in local anaesthesia is a safe, effective and well-tolerated outpatient procedure with a high cancer detection rate. The elimination of infectious complications and its high accuracy make this technique a feasible alternative to the TR approach for the urological office. We assume that the single puncture and our trocar-like access sheath introduction technique diminish tissue trauma and bacterial exposition, and thus contribute to these promising results.

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Acknowledgements

The authors want to thank Dr Selina Ackermann from the University Hospital Basel for editorial assistance.

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Authors and Affiliations

  1. Department of Urology, University Hospital Basel, Basel, Switzerland

    Christian Wetterauer, Joel R. Federer-Gsponer & Hans Helge Seifert

  2. Uro Merian, Basel, Switzerland

    Osama Shahin

  3. University of Basel, Basel, Switzerland

    Nicola Keller

  4. Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland

    Stephen Wyler & Maciej Kwiatkowski

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  1. Christian Wetterauer
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Correspondence to Christian Wetterauer.

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Wetterauer, C., Shahin, O., Federer-Gsponer, J.R. et al. Feasibility of freehand MRI/US cognitive fusion transperineal biopsy of the prostate in local anaesthesia as in-office procedure—experience with 400 patients. Prostate Cancer Prostatic Dis 23, 429–434 (2020). https://doi.org/10.1038/s41391-019-0201-y

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