Initial results of perineal MRI/ultrasound fusion biopsies under local anesthesia without standard perioperative antibiotic prophylaxis

Abstract

The perineal approach for prostate biopsy (PB) is asterile alternative to conventional transrectal PB. Targeted local anesthesia allows perineal prostate biopsy (pPB) to be performed without general anesthesia. This paper presents the first results after establishing perineal MRI/ultrasound fusion biopsy (pFB) under local anesthesia without standard perioperative antibiotic prophylaxis. For this purpose, 144 patients were included in the study after pFB at the Vivantes Klinikum am Urban. No peri-interventional antibiotic prophylaxis was applied. Peri- and postoperatively, the pain sensation, measured using an analogue pain scale from 0-10, and complications were recorded. The median patient age was68 and the median prostate-specific antigen (PSA) value 7.07 ng/ml. In all, 49% of the patients received primary PB. The overall detection rate for prostate cancer (PCa) was 71% and for PI-RADS 3, 4 and 5 was 44, 71 and 92%, respectively. The median pain sensation during biopsy was2. Furthermore, 63% of patients with atransrectal prebiopsy considered this to be more painful and another 20% expressed similar pain levels. Only 1patient developed afebrile urinary tract infection. The pFB of the prostate under local anesthesia without antibiotic, perioperative prophylaxis is asuitable alternative to the transrectal PB with regard to the detection rate of PCa, the side effect profile and the subjective pain perception of the patients during the intervention.