Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis.

Autor: Lopez JF; Churchill Hospital Cancer Centre, Oxford, UK., Campbell A; Churchill Hospital Cancer Centre, Oxford, UK., Omer A; Churchill Hospital Cancer Centre, Oxford, UK., Stroman L; Guy's Hospital, London, UK., Bondad J; The Lister Hospital, Stevenage, UK., Austin T; Queen Alexandra Hospital, Portsmouth, UK., Reeves T; Salisbury District Hospital, Salisbury, UK., Phelan C; Kent and Canterbury Hospital, Canterbury, UK., Leiblich A; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Philippou Y; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Lovegrove CE; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Ranasinha N; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Bryant RJ; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Leslie T; Churchill Hospital Cancer Centre, Oxford, UK., Hamdy FC; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Brewster S; Churchill Hospital Cancer Centre, Oxford, UK., Bell CR; Churchill Hospital Cancer Centre, Oxford, UK., Popert R; Guy's Hospital, London, UK., Hodgson D; Queen Alexandra Hospital, Portsmouth, UK., Elsaghir M; Salisbury District Hospital, Salisbury, UK., Eddy B; Kent and Canterbury Hospital, Canterbury, UK., Bolomytis S; Southmeads Hospital, Bristol, UK., Persad R; Southmeads Hospital, Bristol, UK., Reddy UD; Norfolk and Norwich University Hospital, Norwich, UK., Foley C; The Lister Hospital, Stevenage, UK., van Rij S; Aukland Central Hospital, Auckland, New Zealand., Lam W; Department of Surgery, University of Hong Kong, Hong Kong SAR, China., Lamb AD; Churchill Hospital Cancer Centre, Oxford, UK.; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2021 Sep; Vol. 128 (3), pp. 311-318. Date of Electronic Publication: 2021 Apr 12.
DOI: 10.1111/bju.15337
Abstrakt: Objectives: To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability.
Patients and Methods: Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs).
Results: Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'.
Conclusion: Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.
(© 2021 The Authors BJU International © 2021 BJU International Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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