MP67-18 TRANSPERINEAL SECTOR BIOPSY AS A FIRST-LINE BIOPSY STRATEGY: A MULTI-INSTITUTIONAL ANALYSIS OF 409 PATIENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2014MP67-18 TRANSPERINEAL SECTOR BIOPSY AS A FIRST-LINE BIOPSY STRATEGY: A MULTI-INSTITUTIONAL ANALYSIS OF 409 PATIENTS David Eldred-Evans, Lona Vyas, Janette Kinsella, Peter Acher, and Rick Popert David Eldred-EvansDavid Eldred-Evans More articles by this author , Lona VyasLona Vyas More articles by this author , Janette KinsellaJanette Kinsella More articles by this author , Peter AcherPeter Acher More articles by this author , and Rick PopertRick Popert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2085AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The first-line biopsy strategy for men with suspected prostate cancer has been transrectal ultrasound guided (TRUS) for over 25 years. TRUS biopsy is known to miss a third of clinically significant prostate cancer leading to repeat biopsies in 30-40% of men. In addition, there are safety concerns regarding life-threatening urosepsis in an era of increasing fluoroquinolone antibiotic resistance. Transperineal biopsy is a more comprehensive approach with negligible sepsis, but is usually reserved as a repeat biopsy strategy rather than a first-line approach. This study evaluates the clinical outcomes and complications of first-line transperineal biopsy in a large multi-institutional cohort. METHODS Data were collected on 409 patients who underwent primary transperineal sector biopsy (TPSB) at three participating centres over a 7 year period. Men who had a previous biopsy were excluded. All underwent primary TPSB as a day-case procedure under general or spinal anaesthesia. RESULTS The baseline characteristics and pathological outcomes are shown in Table 1. Prostate cancer was diagnosed in 249 men (62%); this was clinically significant in 187 (46%). There were 43 patients (17%) with cancer located exclusively in the anterior sector. Post biopsy urinary retention occurred in six patients (1.5%). Haematuria requiring overnight hospital admission occurred in 4 patients (1%). There were no cases of urosepsis or anaesthetic complications. The outcomes included discharged (37%), AS (17%), brachytherapy (14%), RRP (16%) and EBRT +/- hormones (15%). CONCLUSIONS TPSB is a safe technique with negligible urosepsis. The high cancer detection rate, compared to similar TRUS biopsy cohorts that detect cancer in 40-44%, is likely due to a more comprehensive assessment of the anterior and apical regions of the prostate. As an initial biopsy strategy, TPSB may reduce the need for repeat biopsy allowing patients with negative biopsies to be confidently discharged, and those with positive biopsies to be accurately risk stratified for appropriate radical treatment or active surveillance. We recommend it be considered as a primary biopsy approach although individual institutions will need to balance the benefits against resources. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e756 Advertisement Copyright & Permissions© 2014MetricsAuthor Information David Eldred-Evans More articles by this author Lona Vyas More articles by this author Janette Kinsella More articles by this author Peter Acher More articles by this author Rick Popert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...