Antibiotic free Local Anaesthetic Transperineal Prostate (LATP) biopsies: a review of the first 791 cases. (RSM Malcolm Coptcoat prize)

Abstract

Introduction
A predominantly nurse-performed LATP service for AS patients, repeat biopsy and anterior lesions, was newly started in July 2019 using PrecisionPoint. Service was expanded in March 2020 to all prostate pathway patients according to BAUS COVID guidance.
Methods
Patients underwent pre-biopsy MRI and image-review meetings. Biopsies were performed in PIRADS3-5, or PSAD>0.15. PIRADS3-5 lesions were targeted with ≥3 cores, systematic Ginsburg protocol biopsies were also performed (all sent separately).
No antibiotics were used. Prospective database at point of care was created detailing demographics, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported.
Results
750 consecutive patients analysed. Detection of significant cancer (Gl≥3+4) in PIRAD1-2/3/4/5 groups was 25%/40%/59%/92%. Systematic biopsy alone detected significant cancer in 36%, systematic plus targeted achieved 63%. Of AS patients; 40% with Gl3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl≥4+3.
Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis.
PROMs demonstrated favourable results in a significant majority (89-98%) of patients.
Conclusion
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.