OBJECTIVE: To describe a protocol for transperineal sector biopsies of the prostate and present the clinical experience of this technique in a UK population.
PATIENTS AND METHODS: A retrospective review of a single-centre experience of transperineal sector biopsies approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24 to 38 cores using a "sector plan". Procedures were carried out under general anaesthetic in the majority of patients. Between January 2007 and August 2011, 634 consecutive patients underwent transperineal sector biopsies for the following indications: prior negative transrectal biopsy (TRB) (n=174); primary biopsy in men at risk of sepsis (n=153); further evaluation following low risk disease diagnosed on the basis of twelve-core TRB (n=307).
RESULTS: Prostate cancer was found in 36% of men following negative TRB; 17% of these had disease solely in anterior sectors. As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA = 7.4 ng/mL). Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment. Post-operative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per-urethral bleeding requiring hospital stay occurred in two men. There were no cases of uro-sepsis.
CONCLUSIONS: Transperineal sector biopsy of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity.
Written by:
Vyas L, Acher P, Challacombe B, Chang RT, Kinsella J, Sturch P, Cahill D, Chandra A, Popert R. Are you the author?
The Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London.
Reference: BJU Int. 2013 Jun 13. Epub ahead of print.
doi: 10.1111/bju.12282
PubMed Abstract
PMID: 24053629
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