Initial Experience Performing In-office Ultrasound-guided Transperineal Prostate Biopsy Under Local Anesthesia Using the PrecisionPoint Transperineal Access System

Urology. 2018 May;115:8-13. doi: 10.1016/j.urology.2018.01.021. Epub 2018 Feb 1.

Abstract

Objective: To describe our procedural technique and initial outcomes performing in-office transperineal prostate biopsies using the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD).

Patients and methods: Following institutional review board approval, we retrospectively reviewed the records of men who underwent an in-office transperineal prostate biopsy using the PrecisionPoint device. Records were reviewed for baseline characteristics, biopsy results, and postbiopsy complications.

Results: Between January 4, 2017 and August 23, 2017, 43 men underwent an in-office transperineal prostate biopsy using the PrecisionPoint Transperineal Access System. Patients had a median serum prostate specific antigen level of 6.1 ng/mL (range 0.8-32.9). Of the 43 biopsies, 12 (27.9%) were performed for active surveillance of low-risk prostate cancer and 31 (72.1%) were performed for cancer screening. Overall, 21 (48.8%) men were found to have prostate cancer. Among those on active surveillance, cancer was detected in 8 of 12 (66.7%) patients, with 2 of 12 (16.7%) found to have Gleason ≥3 + 4 = 7 prostate cancer. Additionally, cancer was detected in 13 of 31 (41.9%) patients undergoing a biopsy for prostate cancer screening, with 5 (16.1%) found to have Gleason ≥3 + 4 = 7 disease. In total, 3 (7.0%) patients experienced a postbiopsy complication: 2 (4.7%) with urinary retention and 1 (2.3%) with gross hematuria requiring catheterization. No patient experienced an infectious complication despite omission of periprocedural antibiotics in all cases.

Conclusion: The PrecisionPoint device allowed for the successful performance of in-office transperineal prostate biopsies under local anesthesia without the need for periprocedural antibiotics. We observed an acceptable cancer detection rate with no infectious complications.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / methods
  • Anesthesia, Local
  • Early Detection of Cancer / instrumentation
  • Early Detection of Cancer / methods
  • Endosonography
  • Humans
  • Image-Guided Biopsy / adverse effects
  • Image-Guided Biopsy / instrumentation*
  • Image-Guided Biopsy / methods*
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Office Visits
  • Perineum
  • Postoperative Complications / etiology
  • Prostate / diagnostic imaging
  • Prostate / pathology*
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / pathology*
  • Retrospective Studies
  • Watchful Waiting / methods