📃 Paper Title: Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis
🧍 Author: J. Francisco Lopez
🕒 Year: 2021
📚 Journal: BJU International
🌎 Country: United Kingdom
ㅤContext to the study:
What is the rate of developing acute urinary retention after transperineal local anaesthetic prostate biopsy?
ㅤ✅ Take-home message of study:
Local anaesthetic transperineal biopsy is putatively advantagenous for reasons of avoiding general anaesthetic and reducing complications related to the transrectal route. This international multicentre prospective cohort study demonstrates that cancer detection rates are excellent alongside good toelrabilility and good safety, especially a very low sepsis rate.
ㅤ Prospective multicentre cohort study
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Study participants:
1218 consecutive patients at 10 centres (UK: 8, Hong Kong: 1, New Zealand: 1) undergoing local anaesthetic transperineal (LATP) biopsy.
55% were first biopsies, 24% were confirmatory biopsies in active surveillance protocols, and 21% were repeat biopsies in men with ongoing suspicion of prostate cancer despite previous negative biopsy/biopsies.
Median age was 68 and median PSA was 7.6 ng/mL. 84% had pre-biopsy mpMRI, reporting a target in 74% of cases
These men underwent LATP using the PrecisionPoint system with perineal skin and periprostatic nerve local anaesthetic block without sedation.
Ginsburg protocol systematic biopsies were performed alongside cognitive-directed MRI-targeted biopsies were applicable.
Prophylactic antibiotics were given according to local practice.
Median cores taken was 24 (range 1-47).
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Key study outcomes:
67% had cancer of any description and 52% had clinically-significant cancer defined as ISUP grade group ≥2. For biopsy-naiive, active surveillance, and re-biopsy cohorts, the rates of any cancer detection were 72%, 73%, and 46%, respectively. The rates of detection of clinically-significant cancer were 83%, 70%, and 68%.
Two cases only (0.16%) of sepsis were reported, one of which was an immunocompromised patient with a pre-existing low-grade UTI. One patient reported uncomplicated epididymo-orchitis. Some patients (number not specified) specified self-limiting vasovagal symptoms during the procedure. 20 patients (1.6%) developed acute urinary retention.
PROMs questionnaires were given to 5 patients in 5 centres. 64% described the procedure as not at all painful or a little painful, whilst 14% found it very painful. 7% found it very embarrassing. 86% felt it was a minor/moderate procedure tolerable under local anaesthetic, whilst 6% described it as a major procedure that should require general anaesthetic.
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Study Limitations:
Heterogeneous cohort reflecting a wide range of centre-specific prostate cancer pathways, including varied patient selection and varied radiologist experience
Observational evidence
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