Transperineal template p rostate b iopsy : a comparison of two techniques

1. No.174 Transperinealtemplate prostate biopsy: a comparison of two techniques Jeremy Grummet1,2, Eldho Paul3 and Mark Frydenberg2 1. Urology Unit, Alfred Hospital, Monash University 2. Epworth Healthcare 3. Dept of Epidemiology and Preventative Medicine, Monash University Posters Proudly Supported by: Results A total of 135 TPT biopsies were performed, comprising 93 and 42 at AH and EH, respectively. The mean age in both groups was 62.5 years (p=1.00). The median PSA was 8.8 and 7.1 (p=0.31) in AH and EH cohorts, respectively. The indications for TPT biopsy at AH and EH respectively were: active surveillance (37% vs 52%, p=0.08), rising PSA despite negative TRUS biopsy (45% vs 36%, p=0.30) and other (18% vs 12%, p=0.35). The “other” indications included: - Inconclusive TRUS biopsy histology - Elevated PSA and inflammatory bowel diease or recent rectal surgery - Microfocus only of Gleason 4+4=8 on TRUS biopsy - Resident in Asia wishing to avoid risk of sepsis Of 36 patients undergoing a pre-biopsy multiparametricMRI, 14 and 22 were AH and EH patients, respectively. MRI correlation with TPT biopsy findings at AH and EH was 57% and 41%(p=0.34). Overall, positive biopsies were found in 37% and 55% (p=0.047) at AH and EH, respectively. This was expected due to the higher proportion of active surveillance patients at EH. Of the positive biopsies, 76% and 91% (p=0.18) included anterior and/or transition zones, and 35% and 48% (p=0.34) involved onlyanterior and/or transition zones at AH and EH, respectively. Of active surveillance patients, cancer in 32% and 36% (p=0.76) were upgraded to Gleason 7 or higher at AH and EH, respectively. Of previously negative TRUS biopsy patients, 33% in both cohorts (p=1.00) had a new diagnosis of prostate cancer. Acute retention and clot retention occurred in 7% and 3% at AH, but there were no episodes of retention at EH. There was no infection in either group. Introduction Transperineal template (TPT) biopsy of the prostate, using a perineally placed brachytherapy template grid and transrectal ultrasound probe, is increasingly used in both diagnosis and monitoring of clinically localised prostate cancer. Its advantages include avoidance of needle passage through the contaminated rectal wall and excellent access to all areas of the prostate, particularly anteriorly. However, the optimal protocol for TPT biopsy remains unknown. Aim We sought to compare two different protocols of TPT biopsy. Methods All patients undergoing TPT biopsy at Alfred Health (AH) from commencement of the procedure in 2009 to June 2012 were included. A retrospective analysis was conducted for patients from 2009 to May 2011. From June 2011 to 2012, a prospective database was kept. A separate prospective database was kept for all patients undergoing TPT biopsy at Epworth Healthcare (EH) by two surgeons (JG and MF). All patients received at least 3 days of a prophylactic oral quinolone. At AH a protocol totalling 20 cores, taking 2 cores each bilaterally from the following locations was used: base, mid-gland and apex of peripheral zone; transition zone; anterior zone. In contrast, a modified Guys Hospital protocol was used at EH (Epworth Protocol). For glands less than 40cc, 3 cores were taken from each of posterior, mid-level and anterior zones bilaterally, totalling 18 cores. For glands greater than 40cc, an additional 3 cores were taken from each side of the base, for a total of 24 cores. In addition, patients with obstructive LUTS were given a perioperative course of alpha blocker. Comparisons of the rates of different indications, MRI correlation, cancer detection and upgrading, and complications were made using chi-square test for equal proportion or Fisher’s exact test where numbers were small. In both cohorts, TPT biopsy offered high rates of upgrading and detection of prostate cancer in patients on active surveillance or with a rising PSA after a negative TRUS biopsy, respectively. A high proportion of cancers were found in anterior or transition zones only. The rate of retention was 10% in the AH group and zero in the EH group, in which prophylactic alpha blockers were given. There was no infection in either cohort. Conclusions Acknowledgements Thanks to Dr Fairleigh Reeves for her collation of data for the Alfred Hospital series. References Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer. H Ahmed, O Akin, J Coleman et al. BJUI 2011. 109, 1636-1647.