Early clinical experience and learning curve of transperineal prostate biopsy with a novel angle-adjustable needle guide

Erdem Öztürk, Tuncel Uzel, Mustafa Işikdoğan^*, İsa Dağli, Nurullah Hamİdİ, Halil Başar
Department of Urology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, 06140, Turkey
* Corresponding Author: Mustafa Işikdoğan. Email: email
(This article belongs to the Special Issue: Advancing Early Detection of Prostate Cancer: Innovations, Challenges, and Future Directions)

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.071101

Received 31 July 2025; Accepted 28 October 2025; Published online 09 December 2025

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Abstract

Background: The European Association of Urology (EAU) recommends transperineal biopsy (TPBx) due to its lower infection risk and higher diagnostic rate for anterior zone tumors. This study aims to assess the learning curve of TPBx using the Perino-Flex^® angle-adjustable needle guide under local anesthesia. Methods: A retrospective observational analysis was conducted from November 2023 to March 2024, involving 100 patients who underwent TPBx with coaxial technique under local anesthesia. Data collected included patient demographics, procedure and room times, pain levels, anxiety scores, and complications. The study focused on comparing procedure times, pain scores, and complication rates to evaluate the learning curve over time. Results: The mean room time significantly decreased from 29.55 min in the first group to 19.95 min in the fifth (p < 0.001). Procedure time was reduced from 15.25 min in the first group to 7.50 min in the fifth (p < 0.001). Visual Analog Scale (VAS) scores during core sampling demonstrated a significant decrease after the first 20 patients (2.70 vs. 0.90 in the first and second quartile, respectively, p < 0.001), indicating a rapid gain in operator proficiency. When splitting the first 20 patients into two subgroups, pain scores significantly dropped after the initial 10 cases. Cancer detection rates remained stable across all groups. Notably, no infectious complications were observed throughout the study. Conclusion: This study highlights the learning curve for TPBx with an adjustable needle guide under local anesthesia. It shows that as experience grows, pain decreases and procedure times shorten, improving both patient comfort and efficiency. These findings offer valuable guidance for new practitioners to learn more quickly and achieve better diagnostic results.