Antibiotic free local anaesthetic transperineal prostate (LATP) biopsies: A review of the first 750 cases

ABSTRACT

INTRODUCTION AND OBJECTIVE: A LATP service using PrecisionPoint™ was newly started in July 2019, with procedures performed by both surgeon and nurse practitioners. Initial indications were repeat biopsy, anterior prostate lesions, and Active Surveillance patients. Service was expanded in March 2020 to all prostate pathway patients according to British Association of Urology COVID guidance. METHODS: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD>0.15. Systematic Ginsburg protocol biopsies were performed for all patients (each zone sent separately), and PIRADS 3-5 lesions were targeted with ≥3 cores (also sent separately). Alpha-blockers were started for patients with Bladder Outlet Obstruction. No antibiotics were used unless patients were immunocompromised or had a previous history of urinary sepsis. A prospective database at point of care was created detailing patient demographics, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. RESULTS: 750 consecutive patients are analysed. Detection of clinically significant prostate cancer (Gl≥3+4) in PIRADS 1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected clinically significant cancer in 36%, whereas systematic plus targeted biopsy achieved 63%. Of Active Surveillance patients;40% with Gl 3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl≥4+3. n=5 (0.6%) experienced vasovagal episodes causing delayed discharge. Only n=5 patients were readmitted (0.6%) 2 urinary tract infection, 2 acute urinary retention, 1 urinary sepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further repeat biopsies (89%). CONCLUSIONS: We have set up a safe, effective, antibiotic free LATP biopsy service, with high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.