365 Local Anaesthetic Transperineal Template Biopsy in the Outpatient Setting: A More Sustainable Option in the NHS?

Abstract

Abstract Introduction Transperineal prostate (TP) biopsies have traditionally been performed under general anaesthesia using a grid plate, ultrasound probe and access cannula. This requires theatre heavy resources. Novel techniques and equipment allow TP biopsies to be performed under local anaesthetic (LA) and are well tolerated. However, this equipment tends to be single use and disposable. Our urology department uses the re-usable BK Medical® needle guide and biplanar probe in the outpatient department (OPD). We present outcomes from patients who have undergone LA prostate biopsies using a re-usable system. Method Data was collected from 92 patients who had TP biopsies in the OPD from November 2020 – August 2021. Clinical parameters including MRI Prostate Imaging-Reporting and Data System (PI-RADS) score, prostate specific antigen (PSA) level, histopathological outcomes, re-biopsy and post-procedure complications were collated. Patient Reported Outcome Measures were collected prospectively. Results Median (range) PSA level was 7 (2.28–59.3)ng/mL. Mean prostate core samples taken were 24(17–40). All procedures were successfully completed under LA. 93% of patients reported a pain score of 3 or less on the visual analogue scale. 93% of patients would recommend this method of biopsy. 44/92(47.8%) had clinically significant prostate cancer (Gleason ≥3+4). Two patients required repeat biopsies, one was benign, the other clinically significant prostate cancer. Conclusions TP biopsies with the re-usable BK Medical® needle probe are effective, safe and well tolerated with an overall one-off cost of £1400 per grid versus £200 per single use kit, and an environmental advantage by being re-useable thereby contributing to NHS sustainability goals.