Transperineal prostate biopsy with cognitive magnetic resonance imaging/biplanar ultrasound fusion: description of technique and early results

  • Michael A. GorinEmail author
  • Alexa R. Meyer
  • Michael Zimmerman
  • Rana Harb
  • Gregory A. Joice
  • Zeyad R. Schwen
  • Mohamad E. Allaf
Original Article



To describe our technique and early results performing transperineal prostate biopsy using cognitive magnetic resonance imaging (MRI)/biplanar ultrasound fusion. Key components of this technique include use of the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD) and simultaneous transrectal ultrasound guidance in the axial and sagittal planes.

Patients and methods

In total, 95 patients (38 studied retrospectively and 57 studied prospectively) underwent a transperineal MRI-targeted prostate biopsy using the technique detailed in this manuscript. All biopsies were performed by a single urologist (MAG). Data were collected with respect to cancer detection rates, tolerability, and complications. The subset of patients who were studied prospectively was assessed for complications by telephone interviews performed at 4–6 days and 25–31 days following the prostate biopsy.


Between February 2018 and June 2019, 95 men underwent a transperineal prostate biopsy using MRI/biplanar ultrasound fusion guidance. Patients had a total of 124 PI-RADS 3–5 lesions that were targeted for biopsy. In total, 108 (87.1%) lesions were found to harbor prostate cancer of any grade. Grade group ≥ 2 prostate cancer was found in 81 (65.3%) of targeted lesions. The detection rates for grade group ≥ 1 and grade group ≥ 2 prostate cancer rose with increasing PI-RADS score. In 65 (68.4%) cases, the patient’s highest grade prostate cancer was found within an MRI target. Additionally, 12 of 55 (21.8%) patients who were found to have no or grade group 1 prostate cancer on systematic biopsy were upgraded to grade group ≥ 2 prostate cancer with MRI targeting. Only 1 (1.1%) patient received periprocedural antibiotics and no patient experienced an infectious complication. Self-limited hematuria and hematospermia were commonly reported following the procedure (75.4% and 40.4%, respectively) and only 1 (1.1%) patient developed urinary retention.


We demonstrate the safety and feasibility of performing transperineal prostate biopsy using cognitive MRI/biplanar ultrasound fusion guidance. The described technique affords the safety benefits of the transperineal approach as well as obviates the need for a formal fusion platform. Additionally, this method can conveniently be performed under local anesthesia with acceptable tolerability.


Prostate biopsy Prostate cancer Transperineal Transrectal PrecisionPoint Fusion biopsy MRI/ultrasound fusion Cognitive fusion MRI targeted 


Author contribution

MAG: protocol/project development, data analysis, and manuscript writing/editing. ARM: protocol/project development, data analysis, and manuscript writing/editing. MZ: data collection or management and manuscript writing/editing. RH: data collection or management and manuscript writing/editing. GAJ: protocol/project development and manuscript writing/editing. ZRS: protocol/project development and manuscript writing/editing. MEA: protocol/project development, data analysis and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interests to disclose.

Ethical approval

Patients in the retrospective cohort were studied following Institutional Review Board Approval with a waiver of consent (Protocol # IRB00198333). Patients in the prospective cohort signed informed consent for study participation (Protocol # IRB00138687). No animals were used in the course of this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Michael A. Gorin
    • 1
    Email author
  • Alexa R. Meyer
    • 1
  • Michael Zimmerman
    • 1
  • Rana Harb
    • 1
  • Gregory A. Joice
    • 1
  • Zeyad R. Schwen
    • 1
  • Mohamad E. Allaf
    • 1
  1. 1.The James Buchanan Brady Urological Institute and Department of UrologyJohns Hopkins University School of MedicineBaltimoreUSA

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