Transperineal template biopsy remains the gold standard investigation in diagnosis of prostate cancer. Data from the PROMIS study demonstrated the low sensitivity of transrectal ultrasound (TRUS) biopsy as a diagnostic tool, and highlighted the need for a better diagnostic pathway. The authors of this article have adopted a transperineal, MRI-targeted approach. Due to the burden on the system and the patient of doing large numbers of these under a general anaesthetic, a local anaesthetic approach has been trialled using a standard brachytherapy grid. The aim of the study was to report on the feasibility, tolerability and detection rates of clinically significant prostate cancer using this approach. While the value of an MRI-targeted approach (as opposed to systematic sampling of normal gland) has been reported in other studies, of greater interest in this paper are the patient-reported outcomes of the local anaesthetic approach. Visual analogue pain scores are given for 20 patients with a median intraoperative score of one (out of 10). One procedure was abandoned due to patient discomfort. One hundred and eighteen men were sent a follow-up questionnaire, and 89% of men who replied would recommend the procedure to others. The authors recognised that the low return rate (40%) was a significant limitation. The main point of interest in this paper is the local anaesthetic technique which is described in detail and may be of value to clinicians considering adopting such an approach in their practice. However, before we can conclude that targeted transperineal biopsy under local anaesthetic is a comparable technique to systematic general anaesthetic biopsies, randomised comparative data may be required and we hope more trials on this topic will follow.
MRI targeted transperineal prostate biopsy: a local anaesthetic approach
Reviewed by Pravisha Ravindra
Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach.
