Churchill Hospital Cancer Centre, Oxford, UK.
Guy's Hospital, London, UK.
BJU Int. 2021 Sep;128(3):311-318. doi: 10.1111/bju.15337. Epub 2021 Apr 12.
To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability.
Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs).
Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'.
Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.
评估使用单点经会阴(transperineal，TP)入路装置进行局部麻醉(transperineal，LATP)的可行性，并报告前列腺癌(prostate cancer，PCa)的初步检出率、感染率和可接受性。
这是一项多中心前瞻性队列观察性研究，纳入所有连续病例。LATP 分别在以下三种情况下进行：(i)疑似 PCa 的首次活检，(ii)主动监测的确认活检，以及 (iii)疑似 PCa 的重复活检。所有患者均按照当地医院指南在术前接受抗生素治疗。局部麻醉通过会阴皮肤浸润和前列腺周围神经阻滞实现，无需镇静。采用 Ginsburg 方案原则进行系统活检，包括在需要时使用 PrecisionPoint™TP 进入装置进行认知磁共振成像靶向活检。前瞻性和连续收集与操作相关的并发症和肿瘤学结果。在一些中心使用经过验证的问卷收集患者报告的结果测量(patient-reported outcome measures，PROMs)数据。
在 10 个中心，共对 1218 例患者进行了 LATP 活检：分别有 55%、24%和 21%的患者进行了上述三种情况下的活检。诊断出任何分级的 PCa 患者 816 例(67%)，其中 634 例(占总数的 52%)存在临床显著疾病。记录到 2 例败血症(0.16%)，19 例患者发生尿潴留(1.6%)。向 419 例患者发放了 PROMs，应答率为 56%(n=234)。在这些男性中，64%的患者描述活检期间的疼痛为“一点也不”或“有点”疼痛。血尿是最常见的报告症状(77%)。在探讨再次活检的态度时，48%的患者表示“没问题”，而 8.1%的患者认为“这是个大问题”。大多数患者(81%)将活检描述为“可在局部麻醉下耐受的轻微或中度程序”，而 5.6%的患者则认为“需要全身麻醉的大程序”。
我们的数据表明，使用超声探头安装的 TP 进入系统进行 LATP 活检可获得优异的 PCa 检出率，败血症发生率非常低，且安全且耐受性良好。我们认为，比较 LATP 与经直肠超声引导活检(transrectal ultrasound-guided biopsy，TRUS)的随机对照试验将有助于调查每种活检技术的相对利弊。
