Outcomes of transperineal template‐guided prostate biopsy in 409 patients
Authors: Symons James L. , Huo Andrew , Yuen Carlo L. , Haynes Anne‐Maree , Matthews Jayne , Sutherland Robert L. , Brenner Phillip , Stricker Phillip D. 
Published: April 2013

What's known on the subject? and What does the study add?
With an aging population and routine use of PSA testing, there is an increase in men undergoing biopsy to assess for prostate cancer. The most common route for accessing the prostate is through the rectum, which potentially exposes the patient to otherwise innocuous Enterobacteriaceae. The rising incidence of extended‐spectrum beta‐lactamase has been linked to a rise in post‐TRUS biopsy infection rates internationally.
The study describes an alternative route for biopsy of the prostate that is associated with a very low infection rate, whilst still maintaining a good tumour detection rate.
Objective
To present the template‐guided transperineal prostate biopsy (TPB) outcomes for patients of two urologists from a single institution.
Patients and Methods
We conducted a prospective study of 409 consecutive men who underwent TPB between December 2006 and June 2008 in a tertiary referral centre using a standardized 14‐region technique.
The procedure was performed as day surgery under general anaesthesia with fluoroquinolone antibiotic cover.
Follow‐up took place within 2 weeks, during which time men were interviewed using a standardized template.
Results were compared with those of the Australian national prostate biopsy audits performed by the Urological Society of Australia and New Zealand (USANZ).
Results
Indications for biopsy included elevated prostate‐specific antigen (PSA) level (75%), with a median PSA level of 6.5 ng/mL, abnormal digital rectal examination (8%) and active surveillance (AS) re‐staging (18%).
The mean patient age was 63 years and two‐thirds of patients were undergoing their first biopsy.
A positive biopsy was found in 232 men, 74% of whom had a Gleason score of ≥7. The overall cancer detection rate was 56.7% (USANZ 2005 national audit = 56.5%). Stratified between those having their first TPB or a repeat procedure (after a previous negative biopsy), the detection rates were 64.4 and 35.6%, respectively. Significantly higher detection rates were found in prostates <50 mL in volume than in larger prostates (65.2 vs 38.3%, respectively, P < 0.001).
Haematuria was the most common side effect (51.7%). Others included dysuria (16.4%), acute urinary retention (4.2%) and fever (3.2%). One patient (0.2%) had septicaemia requiring i.v. antibiotics.
Repeat biopsy was not associated with increased complication rates.
Conclusions
TPB is a safe and efficacious technique, with a cancer detection rate of 56.7% in the present series, and a low incidence of major side effects. Stratified by prostate volume, the detection rate of TPB was higher in smaller glands.
Given the relatively low rate of serious complications, clinicians could consider increasing the number of TPB biopsy cores in larger prostates as a strategy to improve cancer detection within this group. Conversely, in patients on AS programmes, a staging TPB may be a superior approach for patients undergoing repeat biopsy so as to minimize their risk of serious infection.