Transperineal prostate biopsy: The modern gold standard to prostate cancer diagnosis

Abstract

In patients suspicious for prostate cancer, a prostate biopsy should be performed. Biopsies are possible either by the transrectal or transperineal routes. Compared with the transrectal prostate biopsy (TRPBx), transperineal prostate biopsy (TPPBx) offers a non-inferior cancer detection rate (CDR), especially in patients undergoing re-biopsy for persistently elevated PSA and in cases of active surveillance (AS), in which TPPBx seems to be superior. Moreover, the transperineal route achieves superior sampling of the anterior and apical regions, especially after previous multiple negative TRPBx. Infectious complications are nullified due to avoidance of needle passage through the rectal mucosa, and there is a highly significant evidence of reduced fever and sepsis rates when compared with TRPBx, with maintaining acceptable urinary retention rates. This is an important upcoming topic due to the increasing antibiotic resistance rates, thus reducing periinterventional hospitalization and health care costs. To date, TPPBx is perfectly feasible in the inpatient and out-patient settings and under local anesthesia, characterized by a moderate learning curve and a good reproducibility. By applying mpMRI as a diagnostic tool, clinically significant prostate cancer (csPCa) detection seems to be comparable to transrectal MRI-fusion biopsy (TR-MRIFBx). Finally, focal treatment of localized disease is currently performed exclusively through a TP approach.

Figure 1. a–f

Transrectal MRI-fusion biopsy (TRT-MRI-FBx). (a) Lateral sonographic view demonstrating the prostate (red contour), suspicious lesion (green contour), needle (L). (b) Lateral MRI view demonstrating the prostate (red contour), suspicious lesion (green contour), needle (L). (c–f) 3D reconstruction in different views demonstrating the prostate (red), suspicious lesions (blue, green), and needle positions

Figure 2. a–d

Transperineal MRI-fusion biopsy (TP-MRI-FBx). (a) Lateral sonographic view demonstrating the prostate (red contour), suspicious lesion (blue contour), needle (L), and template position (Q-17). (b) 3D reconstruction demonstrating the prostate (red), suspicious lesion (blue), and needle positions. (c) Transverse sonographic view demonstrating the prostate (red contour), suspicious lesion (blue contour), targeted biopsy position (3 cores), last targeted biopsy position (L3). (d) Transverse schematic view demonstrating the prostate (red contour), suspicious lesion (blue contour), and the last targeted biopsy position (L3)