Affiliation:
1. Department of Urology Haukeland University Hospital Bergen Norway
2. Department of Clinical Medicine University of Bergen Bergen Norway
3. Department of Radiology Haukeland University Hospital Bergen Norway
4. Department of Pathology Haukeland University Hospital Bergen Norway
Abstract
ObjectivesTo report a single‐centre experience of a complete transition from transrectal (TR) to transperineal (TP) prostate biopsy under local anaesthesia using a freehand cognitive coaxial approach and without use of antibiotic prophylaxis.Patients and MethodsAnalysis was performed of a prospective database of patients undergoing prostate biopsy performed by four surgeons between 1 June 2018 and 31 May 2022. Outcomes of interest were complications, cancer detection rate, inter‐operator reliability, and tolerability.ResultsOverall, 1915 patients underwent 2337 separate prostate biopsy sessions. Only 2.4% patients in the TP group received antibiotic prophylaxis, while 100% received antibiotics in the TR group. The complication rate was significantly lower in the TP group compared to the TR group (0.3% vs 5.0%, P < 0.001). In contrast to the TR group, there were no cases of urosepsis or admissions to intensive care in the TP group. The total cancer detection rate by TP biopsy was 70% and the overall pathology detection rate was 88.4%. There was no difference in cancer or pathology detection between operators. A stable level of cancer detection was reached early on for both Prostate Imaging‐Reporting and Data System 4 and 5 lesions. All cases performed were performed successfully without need for early termination.ConclusionImplementing a complete transition from TR to TP biopsy can result in a significant reduction in complications and hospital re‐admissions. A cognitive freehand coaxial technique is well tolerated by patients and achieves a high cancer detection rate.
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