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Keywords:

  • transperineal biopsy;
  • prostate cancer;
  • biopsy;
  • staging;
  • complications;
  • active surveillance

Objective

  • To describe a protocol for transperineal sector biopsies (TPSB) 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 TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24–38 cores using a ‘sector plan’. Procedures were carried out under general anaesthetic in most patients.
  • Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low-risk disease diagnosed based on a 12-core TRB (307).

Results

  • Prostate cancer was found in 36% of men after a 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 level was 7.4 ng/mL).
  • Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment.
  • Postoperative 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 urosepsis.

Conclusions

  • TPSB of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity.