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Sectoral cancer detection and tolerability of freehand transperineal prostate biopsy under local anaesthesia

Prostate Cancer and Prostatic Diseases volume 24, pages 431–438 (2021)Cite this article

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Abstract

Background

To investigate the feasibility of a freehand transperineal (TP) systematic prostate biopsy protocol under local anaesthesia (LA) and the value of different sectors in diagnosing prostate cancer (PCa).

Methods

A total of 611 consecutive freehand TP biopsies under LA in 2 hospitals were prospectively evaluated. Cancer detection rate in each of the four different sectors (anterior, mid, posterior, basal) was recorded to evaluate the value of each sector. Procedure tolerability was assessed by pain score and complications were documented.

Results

Systematic biopsies were performed in 556 out of 611 men with a median of 20 (IQR 12–24) biopsy cores taken. The median PSA was 9.9 (Inter-quartile range[IQR] 6.4–16.2) ng/mL, and 89.0% were first biopsies. All PCa and ISUP grade group (GG) ≥ 2 PCa (HGPCa) were diagnosed in 41.4% (230/556) and 28.2% (157/556) biopsies respectively. 77.0% HGPCa was diagnosed in ≥2 sectors. Single-sector HGPCa was predominantly found in anterior or posterior sector. Omitting base sector would have missed 1.5% (1/65) HGPCa out of the 219 cases with ≥24-core biopsies performed. Further omission of mid sector would have missed 3.1% (2/65) HGPCa and 7.4% (7/94) ISUP GG1 PCa (in which 3/7 involved 2 sectors). LA TP biopsy was well tolerated and the mean pain scores of the different steps of the procedure were between 1.9–3.1 (out of 10). Post-biopsy fever occurred in 0.3% of patients (2/611) and no sepsis was reported. The risk of urinary retention in men with ≥20 cores in ≥60 ml prostate was 7.8% (14/179), compared with 1.7% (7/423) in other groups (p < 0.001).

Conclusions

TP sectoral prostate biopsy under LA was well tolerated with minimal sepsis risk. Basal sector biopsies had minimal additional value to HGPCa detection and its omission can be considered.

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Fig. 1: Local anaesthesia and Biopsy in freehand transperineal prostate biopsy.
Fig. 2: Schematic diagram of different biopsy sectors in the prostate viewed in sagittal plane.

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Author notes

  1. These co-first authors contributed equally: Peter Ka-Fung Chiu, Ka-Lun Lo.

Authors and Affiliations

  1. SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China

    Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, Siu-Fai Ma, Chi-Ho Leung, Ho-Fai Wong, Kittisak Sae-Lo, Sze-Wan Kwok, Suk-Yin Li, Chi-Hang Yee, See-Ming Hou & Chi-Fai Ng

  2. Division of Urology, Department of Surgery, North District Hospital, Hong Kong SAR, China

    Ka-Lun Lo & Kai-Man Li

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Chiu, P.KF., Lo, KL., Teoh, J.YC. et al. Sectoral cancer detection and tolerability of freehand transperineal prostate biopsy under local anaesthesia. Prostate Cancer Prostatic Dis 24, 431–438 (2021). https://doi.org/10.1038/s41391-020-00293-1

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