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Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution

Prostate Cancer and Prostatic Diseases volume 24, pages 169–176 (2021)Cite this article

Subjects

Abstract

Background

Transrectal (TR) and transperineal (TP) approaches for prostate biopsy have different morbidity profiles. Our institution transitioned to a preference for multiparametric MRI-based triage and TP biopsy since 2014. The aim of this study was to compare clinical, microbiological and health economic outcomes between TR and TP prostate biopsy.

Methods

A consecutive cohort study considered prostate biopsies over an 11 year period. Hospital presentations across the region within 30 days of biopsy were analysed for details and subsequent outcomes according to biopsy approach. Cost for each encounter (routine and unplanned) were analysed and generalised linear models applied, as well as cost implications for inclusion of mpMRI-based triage and TP biopsy preference.

Results

In total, 2048 prostate biopsies were performed. Similar re-presentation rates per occurred for each biopsy approach (90 patients, TR 4.8%, TP 3.8%, p = 0.29), with 23 patients presenting more than once (119 total presentations). Presentations after TR biopsy were more likely to be of infectious aetiology (TR 2.92%, TP 0.26% de novo, p < 0.001) and result in hospital admission (TR 43/49, 93.4%; TP 14/24, 58.3%; p = 0.007) for similar rates of urinary retention (TR 2.76% vs TP 3.63%, p = 1). The mean overall cost (biopsy and re-presentations) was higher for the TP group (p < 0.001), adjusted for year and age, but reduced over time and was similar for patients who re-presented (p = 0.98). Incorporation of mpMRI (with subsequently avoided biopsies), TP biopsy and re-presentations resulted in AU$783.27 saving per biopsy.

Conclusions

TR biopsy resulted in more infectious complications and hospital admissions than TP biopsy for similar rates of re-presentation and urinary retention. TP biopsy costs reduced over time and use in conjunction with mpMRI provides an overall cost saving. Routine TP biopsy is safe and feasible, with further cost savings expected with other approaches (local anaesthetic) under investigation.

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Fig. 1: Prostate biopsies performed over study period (2006–2017);
Fig. 2: Prostate biopsy cost analysis;

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Acknowledgements

We wish to thank the urologists involved in patient care for the duration of this study.

Funding

MJR is supported by a Clinician Research Fellowship from the Metro North Office of Research, Queensland Health, and a Doctor in Training Research Scholarship from Avant Mutual Group Pty Ltd.

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Authors and Affiliations

  1. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Matthew J. Roberts, Alastair Macdonald, Patrick E. Teloken, Geoff Coughlin, Nigel Dunglison, Rachel Esler, Robert A. Gardiner & John Yaxley

  2. The University of Queensland, Centre for Clinical Research, Brisbane, QLD, Australia

    Matthew J. Roberts, Patrick Harris, David Paterson & Robert A. Gardiner

  3. Department of Urology, Redcliffe Hospital, Redcliffe, QLD, Australia

    Matthew J. Roberts & Sachinka Ranasinghe

  4. The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia

    Sachinka Ranasinghe, Harrison Bennett, Patrick Harris & John Yaxley

  5. Pathology Queensland, Department of Microbiology, Central Laboratory, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Sachinka Ranasinghe, Harrison Bennett & Patrick Harris

  6. Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    David Paterson

  7. Griffith University, Mount Gravatt, QLD, Australia

    Robert A. Gardiner

  8. Edith Cowan University, Joondalup, WA, Australia

    Robert A. Gardiner

  9. Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

    Thomas Elliott & Louisa Gordon

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Roberts, M.J., Macdonald, A., Ranasinghe, S. et al. Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution. Prostate Cancer Prostatic Dis 24, 169–176 (2021). https://doi.org/10.1038/s41391-020-0263-x

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