Introduction of free-hand MRI-guided transperineal prostate biopsies as an outpatient procedure

INTRODUCTION. Direct biopsy of the prostate is used for diagnosing prostate cancer and most prostate biopsies are performed transrectally with ultrasonic guidance (TRUS-BX). The transrectal approach carries a risk of sepsis as bacteria may transfer directly into the prostate from the rectum. Approximately 6% of the patients will be hospitalised within seven days after TRUX-BX. Increasing antibiotic resistance has spurred a renewed interest in the transperineal approach (TP-BX). Aseptic TP-BX may be performed, significantly reducing the risk of infection. We described the first Danish experience with multiparametric MRI-guided freehand TP-BX.METHODS. Men scheduled for TP-BX were included. Patient age, prostate-specific antigen level, previous biopsy history, weight and height were recorded. We employed a visual analogue scale (VAS) for the various procedure parts and the patients rated their satisfaction. Complications and International Society of Urological Pathology scores were recorded and cancer detection rates calculated.RESULTS. A total of 143 men had TP-BX performed in a consecutive series. The cancer detection rate was 81.8% (95% confidence interval: 74.5-87.8%). The procedure was well tolerated with a median VAS of 2 (range: 0-7), and patients expressed a high degree of satisfaction with the procedure. One patient was hospitalised due to infection.CONCLUSION. TP-BX is well tolerated and feasible as an outpatient procedure performed in local anaesthesia. Transperineal biopsies have a low risk of infection.