Background:
Prostate cancer is one of the most diagnosed cancers in Australian males and is one that has a high mortality in those aged 60 and above. Biopsy is integral in the diagnosis and management of patients at risk of, or being treated for, prostate cancer. Biopsy can be obtained either transrectally or transperineally. Transperineal biopsy methods have increased in popularity as transrectal biopsies carry a small but serious risk of urosepsis. If accurately done under local anaesthetic rather than general anaesthetic, this method could prove a more accurate and accessible method for obtaining biopsy in settings that may have limited theatre access.
Objectives:
This study looks at the safety profile and outcome of patients who have had freehand transperineal (FHTP) biopsy under local anaesthetic.
Methods:
A retrospective review of all FHTP biopsies done by a single surgeon between 2013 and 2015 was performed.
Variables recorded for this study were age, pre-biopsy PSA, DRE findings, outcome of biopsy (and if positive, ISUP grading of cancer), location of cancer and post-biopsy complications were recorded using Clavien-Dindo classification.
Results:
Fifty-eight patients were included in this study aged 48-78 (mean 67.6 years old, standard deviation 6.9 years). Patients had a pre-biopsy PSA reading of 0.2-93 (median 7.9). 14 cores were taken from each patient. DRE was abnormal in 35 men.
Thirty-seven patients had positive biopsies (63.8%). Of those patients that had a positive biopsy, 10 had ISUP grade 1 cancer (27.0%), 8 had ISUP grade 2 cancer (21.6%), 6 had ISUP grade 3 cancer (16.2%), 6 had ISUP grade 4 cancer (16.2%) and 7 had ISUP grade 5 cancer(19.0%).
Ten patients recorded complications. All patients with Clavien-Dindo Grade I complications (n=8) self-resolved with no further medical management. The patient with the urinary tract infection was successfully treated with oral antibiotics and did not require hospitalization. One patient recorded a cardiac event. The aetiology of the patient’s cardiac event was unknown.
Conclusion:
This study shows that freehand transperineal biopsy under local anaesthetic has a higher detection rate and better safety profile compared to transrectal biopsy as it virtually eliminates the risk of dangerous urosepsis.
