Conventional Transrectal Biopsy Research Articles

Developments in optimizing transperineal prostate biopsy.

Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal approach as it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in transperineal prostate biopsy that may optimize the way biopsies are performed in clinical practice. Similarly, to transrectal biopsy, the transperineal approach also allows for the performance of systematic and MRI-targeted biopsy cores. As transperineal biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to transrectal biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, although transperineal biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for transperineal biopsy scaled nationally will likely result in significant healthcare savings. Transperineal biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional transrectal biopsy. Transperineal biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.

Candidate Selection for Prostate Cancer Focal Therapy

Focal therapy has emerged as a potential treatment paradigm for men with localized prostate cancer, because it serves as a medium between the ambiguity of surveillance and the potential reduction of quality of life observed with radical treatment. Candidate selection remains the major challenge of implementing focal therapy in clinical practice. While focal therapy is potentially widely applicable, there is general consensus that initial efforts to initiate focal therapy protocols in practice should be limited to men with disease features that are low to low-intermediate risk, thereby limiting the likelihood of early systemic failure. Selection of candidates is first dependent on the intent of focal therapy. Curative intent focal therapy is limited to a small number of men with isolated, low-risk, unifocal, or unilateral disease. In men for whom local control-and potential prolongation of the natural history of disease-is desired, mapping strategies would focus on identification of the dominant site of disease and ruling out high-risk features. Tools such as conventional transrectal biopsy, transperineal saturation biopsy, and prostate MRI all have relative merits and shortcomings. While ultimately limitation of biopsy is desirable through combinations of transrectal biopsy and imaging, for now, limitations of conventional imaging modalities make it likely that most men will need transperineal saturation biopsy before inclusion in focal therapy protocols.