Open Access

ARTICLE

Initial transperineal prostate biopsy experience at a high-volume center

Aaron Berkenwald, Kristian D. Stensland, Luke E. Sebel, Alireza Moinzadeh, William Faust

Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
Address correspondence to Dr. Aaron Berkenwald, Department of Urology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805 USA

Canadian Journal of Urology 2021, 28(3), 10692-10698.

Abstract

Introduction: Transperineal prostate biopsy (TPBx) allows for prostate cancer detection with fewer infectious complications when compared to transrectal prostate biopsy (TRUSBx). We evaluated the initial experience of a single physician with no prior TPBx exposure, compared to TRUSBx and MRI/US fusion biopsy (MRIBx) performed by experienced physicians.
Materials and methods: All consecutive patients undergoing prostate biopsy (June 2019-March 2020) were included. Patient discomfort, procedural time, clinically significant cancer detection rates (csCDR), and 30-day complications were compared between TPBx, TRUSBx, and MRIBx.
Results: A total of 303 patients underwent biopsy. Comparing TPBx to TRUSBx to MRIBx, median pain scores during the anesthetic block were 4 versus 2 versus 3 (p = 0.007) respectively, and not statistically different during the rest of the procedure. Median time of biopsy was 11, 7.5, and 12 minutes respectively. csCDR were 38%, 29.8%, and 43.6% (p = 0.12) respectively. The combined transrectal groups (n = 211) had nine complications including two sepsis events. The TPBx group (n = 92) had no 30-day complications.
Conclusions: TPBx was well tolerated in the office setting with similar levels of discomfort for all aspects of the procedure compared to the transrectal approach. Learning curve for TPBx showed rapid improvement in procedural time within the first 15 cases with an average procedure time of 9 minutes thereafter. Similar rates of csCDR were found between the groups and TPBx had significantly fewer infectious complications than the standard transrectal technique.

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