422 Local Anaesthetic Trans-Perineal Prostate Biopsy: Outcomes from Our First 250 Cases

Aim

Trans-perineal ultrasound prostate biopsy (TPBx) with prior multiparametric MRI (mpMRI) represents the standard of care in prostate cancer diagnostic. We present our first experience with TPBx in our unit. We also looked at discrepancies between the mpMRI and the TPBx results.

Method

We performed a retrospective analysis of collected data from all the patients who underwent TPBx following mpMRI from March 2021 to June 2022. All patients had combined systematic and targeted prostate biopsies.

Results

The total 250 patients underwent TPBx. 10 patients were already known to have prostate cancer. The mean age was 69 years. The average PSA value was PSA: 8.41 ng/ml with an average PSA density of 0.23.

43 patients underwent previous transrectal ultrasound-guided prostate (TRUS) biopsy while 207 patients were biopsy naïve.

The overall cancer detection rate was 76 %. In 25 % of patients, there were some discrepancies between the mpMRI lesion site and histology results.

Majority of the histology results were ISUP grade group 2, 30 % of the case, grade group 3 in 22 % of the cases, grade group 4 in 14 % of the cases, grade group 1 in 6% of the cases grade group 5 in 2 % of the cases.

Conclusions

A higher PIRADs score is likely to be associated with a higher -grade group histology. Our cancer detection rate is acceptable in comparison to TRUS prostate biopsy (76 % vs 40 %), however there are some discrepancies between the mpMRI and biopsy results which suggests additional criteria are needed to aid in decision management (like PSA density).