Outcomes of local anaesthetic transperineal biopsies in the outpatient setting: How does this compare to conventional biopsy methods?
BAUS ePoster online library. Maliyil J. Jun 26, 2018; 211340; P6-8
Jed Maliyil
Jed Maliyil
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Abstract
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Introduction: Traditionally, prostate biopsies in the outpatient department use the transrectal (TRUS) approach. The PrecisionPoint™ transperineal (TP) system facilitates freehand transperineal biopsy under local anesthetic (LA).

Methods: 176 patients underwent freehand TP biopsies between April 2016 and September 2017. 16(9%) were performed under LA + Sedation and 160(91%) under LA alone. Pain scores using the validated 'Visual Analogue Score' and histological outcomes were compared with contemporary TRUS and standard transperineal template biopsies from our prospective database.

Results: Mean age was 65 years (36-83), median PSA 7.9ng/ml (0.7-1374) and mean prostate volume 45.5cc (15-157). The indication for biopsy was for primary diagnosis (88.6%). Cognitively targeted biopsies were performed in 45(26%) patients; 40(23%) had target + systematic biopsies; and 91(52%) patients underwent systematic biopsies only. Of the 75 cases who had primary systematic biopsies alone, 46(61%) were positive. This was similar to standard transperineal template (68%, 32/47, P=0.51) and TRUS biopsy (62%, 61/98, P=0.90) methods. When comparing TP freehand vs. TRUS biopsy methods, VAS scores were not significantly different for any procedural stage: Probe insertion (P=0.61), LA administration (P=0.32), Biopsies (P=0.51) and Overall (P=0.28). Pain scores were significantly less for Probe insertion in the TP freehand group (P<0.0001) vs. LA standard template biopsies, and P=NS for other stages. No patients developed urinary sepsis.

Conclusions: Prostate biopsies can be performed safely under LA using the PrecisionPoint™ system and are well tolerated. Cancer pickup rates are equivalent to conventional biopsy methods. This method has a potential to replace the TRUS approach in the outpatient setting.
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