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. 2021 Sep 10;2(6):428-435.
doi: 10.1002/bco2.106. eCollection 2021 Nov.

Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

Donnacha Hogan  1   2 , Abbie Kanagarajah  1   3 , Henry H Yao  1 , David Wetherell  1   4 , Brendan Dias  1 , Phil Dundee  1 , Kevin Chu  1   4 , Homayoun Zargar  1 , Helen E O'Connell  1
Affiliations

Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

Donnacha Hogan et al. BJUI Compass. .

Abstract

Objectives: To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost.

Methods: A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization.

Results: This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate-specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging-reporting and data system (PI-RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001).

Conclusion: This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.

Keywords: cancer detection; complications; local anaesthesia; prostate cancer; tolerability; transperineal biopsy.

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Conflict of interest statement

We confirm that this paper has not been published or submitted for publication elsewhere and that all authors have contributed significantly and are all in agreement with the content of the manuscript. The following apply to all listed authors: All support for the present manuscript (e.g., funding, provision of study materials, medical writing, and article processing charges): noneGrants or contracts from any entity: noneRoyalties of licenses: noneConsulting fees: nonePayment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events: nonePayment for expert testimony: noneSupport for attending meetings and/or travel: nonePatents planned, issued, or pending: noneParticipation on a data safety monitoring board or advisory board: noneLeadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: noneStock or stock options: noneReceipt of equipment, materials, drugs, medical writing, gifts, or other services: noneOther financial or nonfinancial interests: none

References

    1. Grummet J, Gorin MA, Popert R, et al. “TREXIT 2020”: why the time to abandon transrectal prostate biopsy starts now. Prostate Cancer Prostatic Dis. 2020;23(1):62–5. - PMC - PubMed
    1. Skouteris VM, Crawford ED, Mouraviev V, et al. Transrectal ultrasound‐guided versus transperineal mapping prostate biopsy: complication comparison. Rev Urol. 2018;20(1):19–25. - PMC - PubMed
    1. Grummet JP, Weerakoon M, Huang S, et al. Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int. 2014;114(3):384–8. - PubMed
    1. Ong WL, Weerakoon M, Huang S, et al. Transperineal biopsy prostate cancer detection in first biopsy and repeat biopsy after negative transrectal ultrasound‐guided biopsy: the Victorian transperineal biopsy collaboration experience. BJU Int. 2015;116(4):568–76. - PubMed
    1. Tamhankar AS, El‐Taji O, Vasdev N, Foley C, Popert R, Adshead J. The clinical and financial implications of a decade of prostate biopsies in the NHS: analysis of hospital episode statistics data 2008‐2019. BJU Int. 2020;126(1):133–41. - PubMed

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