MP24-16 LOCAL ANAESTHETIC TRANSPERINEAL PROSTATE (LATP) BIOPSY USING THE PRECISION POINT ACCESS SYSTEM: A MULTI-CENTRE OUTCOME ANALYSIS

Abstract

INTRODUCTION AND OBJECTIVES: With infection rates and quinolone resistance increasing, we require straightforward alternatives to transrectal biopsy. TP biopsy has historically been more expensive to deliver and dependent on GA and operating theatre facilities. We investigated the use of a TP access system, Precision Point, under LA in the outpatient setting, and assessed sampling of the prostate and tolerability. METHODS: Case selection: Patients with TRUSBx histological discordance, active surveillance and cancer screening. ANTIBIOTICS: Patients received pre-procedure antibiotics in accordance with local hospital guidelines. EQUIPMENT: PrecisionPoint™ transperineal access system. Triplane or biplane transrectal ultrasound transducer in biplane mode. LA TECHNIQUE: Subcutaneous perineal nerve block + prostatic apex block + periprostatic nerve block (PPNB). No sedation. BIOPSY PROTOCOL: Free hand transperineal biopsy using Ginsburg protocol ± Cognitive MRI supported targeted biopsies. DATA: Prospectively collected. RESULTS: Characteristics: 116 patients underwent LATP Biopsy from 4 institutions. 21 (18%) were performed for active surveillance and cancer was detected in 15 (71.4%) patients. 69 (59%) were performed for cancer screening. 26 (22.4%)were re-classification biopsies. Median age was 65.5(48-79)years, median PSA 7.5 (2.6-43)ng/ ml; median prostate volume 121.6(24-217)cc. and median number of biopsies was 24 (16-32). Complications: There was no urinary retention or procedures abandoned due to pain. 3 patients experienced vaso-vagal episodes. 1 patient developed haematoma. 1 patient developed epididymo-orchitis within 2 weeks and was the only re-admission. Oncologic outcomes: Prostate cancer was found in 72/116 (62%) patients of which 57 (49%) had clinically significant prostate cancer. Patient reported outcomes: 4 out of 34 men (11.8%) said a repeat biopsy would be a significant problem. 11 out of 34 (32.4%) said it would be no problem at all. CONCLUSIONS: LATP biopsy using a Transperineal Access System is safe and well tolerated. The procedure is more flexible and efficient than traditional stepper systems. We encourage other centres to adopt this technique. We also anticipate use of MRIeUS fusion using this technique in the outpatient setting.