Transperineal biopsy of the prostate—is this the future?

• Published in: Nature reviews. Urology Vol. 10; no. 12; pp. 690 - 702
• Main Authors: Chang, Dwayne T. S., Challacombe, Benjamin, Lawrentschuk, Nathan
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2013; Nature Publishing Group
• Subjects: 631/67/589/466; 692/699/2768/466; 692/699/2768/589/466; 692/699/67/589/466; 692/700/139; Biopsy; Biopsy, Needle - trends; Care and treatment; Diagnosis; Diagnosis, Ultrasonic; Health aspects; Humans; Learning curves; Male; Medicine & Public Health; Neoplasm Staging - methods; Neoplasm Staging - trends; Patients; Prostate; Prostate cancer; Prostatic Neoplasms - diagnosis; Reproducibility of Results; review-article; Risk factors; Sepsis; Ultrasonic imaging; Ultrasonography, Interventional; Urology; United Kingdom; Australia
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/nrurol.2013.195

Key Points Transperineal prostate biopsy provides better anteroapical sampling than transrectal ultrasonography (TRUS)-guided biopsy, leading to improved cancer detection rates Although usually used as a confirmatory test after negative TRUS-guided biopsy, transperineal biopsy shows promise as an initial investigation Transperineal biopsy frequently requires higher levels of anaesthesia relative to TRUS-guided biopsy, especially when >10–12 cores are taken In patients at high risk of infection (such as those with diabetes mellitus or who recently travelled to countries with high prevalence of antimicrobial resistance), transperineal biopsy is safer than TRUS-guided biopsy in terms of reducing sepsis Multiparametric MRI technology improves the cancer detection rate and accuracy of disease grading in needle biopsy and enables targeted biopsy, which reduces the risk of complications Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). The authors describe the evolution of both the prostate biopsy techniques, focusing on the clinical implications of the transperineal approach and the potential future directions for prostate biopsy. Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved sampling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more-accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy.