Utility of a Novel Platform for Performing Prostate Biopsy - Results of the first 750 patients using a Free Hand Ultrasound Guided Local Anaesthetic Transperineal Prostate (LATP) Technology

Abstract

Introduction & Objective: Prostate Biopsy remains the gold standard for histological confirmation of prostate cancer. The near exponential increase in the need for biopsies, in selected men, has ushered an evolving need for improving detection rates while reducing side effects. Diagnostic accuracy and infection complication rates remain obstacles in transrectal prostate biopsy. PrecisionPoint is a disposable, low cost device which enables transperineal biopsy in the outpatient setting under local anaesthetic.

We present data from a predominantly nurse-performed LATP service using PrecisionPoint, which was newly started in July 2019. Initial indications were; repeat biopsy, anterior lesions, and active surveillance patients. Service was expanded in March 2020 to all prostate pathway patients following national COVID guidance.

Methods:
All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD >0.15. PIRADS 3-5 lesions were targeted with ≥3 cores (sent separately). Systematic Ginsburg protocol biopsies were also performed (each zone sent separately). Tamsulosin was started for BOO patients.

No antibiotics were used unless immunocompromised or previous sepsis. A prospective database at point of care was created detailing patient information, 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% respectively. 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.

5 experienced vasovagal episodes. Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis.

PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further biopsies (89%).

Conclusions:
Adoption of this new technology into an integrated prostate cancer diagnostic pathway has enabled us to set up a safe, effective, antibiotic free LATP biopsy service in the outpatient setting. Data shows high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.