Advertisement

Transperineal Biopsy Technique

  • Nelson N. StoneEmail author
  • Vassilios M. Skouteris
  • E. David Crawford
Chapter
  • 742 Downloads

Abstract

Transperineal prostate mapping biopsy (TPMB) is an alternative method to standard transrectal ultrasound guided (TRUS) technique to sample the gland. The TPMB technique uses a grid placed against the perineum and in a sterile fashion takes biopsy specimens at 5 mm intervals using a combination of transverse and sagittal imaging. In contrast to the TRUS method where 12–18 samples are typically taken, with the TPMB upwards of 50 biopsies are done. Because the TPMB takes more samples and takes them throughout the volume of the prostate, the results are substantially different than the TRUS method. On average the TPMB finds 30 % more cancers when a TRUS biopsy is negative, upgrades low risk cancers that were initially diagnosed by TRUS, and excludes patients from focal therapy because of high incidence of multifocality. Whereas an increasing incidence of flouroquinolone resistant prostate infection and sepsis is associated with TRUS biopsy, hematuria and retention are more common with TPMB.

Keywords

Prostate cancer Prostate biopsy Mapping biopsy Prostatitis Urinary retention Hematuria 

Abbreviations

AS

Active surveillance

EBRT

External beam irradiation

RP

Radical prostatectomy

TPMB

Transperineal prostate mapping biopsy

TRUS

Transrectal ultrasound

Supplementary material

Video 5.1

Video of transperineal biopsy technique (MP4 58,591 kb)

References

  1. 1.
    Lee F. Transrectal ultrasound in the diagnosis, staging, guided needle biopsy, and screening for prostate cancer. Prog Clin Biol Res. 1987;237:73–109.PubMedGoogle Scholar
  2. 2.
    Stein BS, Vangore S, Petersen RO, Kendall AR. Immunoperoxidase localization of prostate-specific antigen. Am J Surg Pathol. 1982;6(6):553–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Horoszewicz JS, Kawinski E, Murphy GP. Monoclonal antibodies to a new antigenic marker in epithelial prostatic cells and serum of prostatic cancer patients. Anticancer Res. 1987;7(5B):927–35.PubMedGoogle Scholar
  4. 4.
    Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med. 1987;317(15):909–16.CrossRefPubMedGoogle Scholar
  5. 5.
    Brawer MK, Lange PH. Prostate-specific antigen and premalignant change: implications for early detection. CA Cancer J Clin. 1989;39(6):361–75.CrossRefPubMedGoogle Scholar
  6. 6.
    Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, Petros JA, Andriole GL. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med. 1991;324(17):1156–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Silverberg E, Lubera J. CA Cancer J Clin. 1987;37(1):2–19.CrossRefPubMedGoogle Scholar
  8. 8.
    Garfinkel L. CA Cancer J Clin. 1993;43(1):5–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Garfinkel L. CA Cancer J Clin. 1995;45(1):5–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Cunningham MP. CA Cancer J Clin. 1997;47(1):3–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Siegel R, Ma J, Zou Z, Jemal A. CA Cancer J Clin. 2014;64(1):9–29.CrossRefPubMedGoogle Scholar
  12. 12.
    Stone NN, Crawford ED, DeAntoni EP, Prostate Cancer Education Council. Screening for prostate cancer by digital rectal exam and prostate specific antigen: results of prostate cancer awareness week, 1989–1992. Urology. 1994;44(6):18–25.CrossRefGoogle Scholar
  13. 13.
    Vallancien G, Leo JP, Brisset JM. Transperineal prostatic biopsy guided by transrectal ultrasonography. Prog Clin Biol Res. 1987;243B:25–7.PubMedGoogle Scholar
  14. 14.
    United States biopsy procedures outlook to 2020, Global Data, July 2014.Google Scholar
  15. 15.
    Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, Yamamoto T, Mamedov A, Loblaw A. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33:272–7.Google Scholar
  16. 16.
    Meiers I, Waters DJ, Bostwick DG. Preoperative prediction of multifocal prostate cancer and application of focal therapy: review 2007. Urology. 2007;70(6 Suppl):3–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Ploussard G, Salomon L, Xylinas E, Allory Y, Vordos D, Hoznek A, Abbou CC, de la Taille A. Pathological findings and prostate specific antigen outcomes after radical prostatectomy in men eligible for active surveillance--does the risk of misclassification vary according to biopsy criteria? J Urol. 2010;183(2):539–44.CrossRefPubMedGoogle Scholar
  18. 18.
    Shapiro RH, Johnstone PA. Risk of Gleason grade inaccuracies in prostate cancer patients eligible for active surveillance. Urology. 2012;80(3):661–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Beauval JB, Ploussard G, Soulié M, Pfister C, Van Agt S, Vincendeau S, Larue S, Rigaud J, Gaschignard N, Rouprêt M, Drouin S, Peyromaure M, Long JA, Iborra F, Vallancien G, Rozet F, Salomon L, Members of Committee of Cancerology of the French Association of Urology [CCAFU]. Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study. Urology. 2012;80(3):656–60.CrossRefPubMedGoogle Scholar
  20. 20.
    Giannarini G, Autorino R, di Lorenzo G. Saturation biopsy of the prostate: why saturation does not saturate. Eur Urol. 2009;56(4):619–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Brede CM, Douville NJ, Jones S. Variable correlation of grid coordinates to core location in template prostate biopsy. Curr Urol. 2013;6(4):194–8.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Huo AS, Hossack T, Symons JL, PeBenito R, Delprado WJ, Brenner P, Stricker PD. Accuracy of primary systematic template guided transperineal biopsy of the prostate for locating prostate cancer: a comparison with radical prostatectomy specimens. J Urol. 2012;187(6):2044–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Katz DJ, Pinochet R, Richards KA, Godoy G, Udo K, Nogueira L, Cronin AM, Fine SW, Scardino PT, Coleman JA. Comparison of transperineal mapping biopsy results with whole-mount radical prostatectomy pathology in patients with localized prostate cancer. Prostate Cancer. 2014;2014:781438.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Crawford ED, Rove KO, Barqawi AB, Maroni PD, Werahera PN, Baer CA, Koul HK, Rove CA, Lucia MS, La Rosa FG. Clinical-pathologic correlation between transperineal mapping biopsies of the prostate and three-dimensional reconstruction of prostatectomy specimens. Prostate. 2013;73(7):778–87.CrossRefPubMedGoogle Scholar
  25. 25.
    Symons JL, Huo A, Yuen CL, Haynes AM, Matthews J, Sutherland RL, Brenner P, Stricker PD. Outcomes of transperineal template-guided prostate biopsy in 409 patients. BJU Int. 2013;112(5):585–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Li H, Yan W, Zhou Y, Ji Z, Chen J. Transperineal ultrasound-guided saturation biopsies using 11-region template of prostate: report of 303 cases. Urology. 2007;70(6):1157–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Moran BJ, Braccioforte MH, Conterato DJ. Re-biopsy of the prostate using a stereotactic transperineal technique. J Urol. 2006;176(4 Pt 1):1376–81.CrossRefPubMedGoogle Scholar
  28. 28.
    Novara G, Boscolo-Berto R, Lamon C, Fracalanza S, Gardiman M, Artibani W, Ficarra V. Detection rate and factors predictive the presence of prostate cancer in patients undergoing ultrasonography-guided transperineal saturation biopsies of the prostate. BJU Int. 2010;105(9):1242–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Pal RP, Elmussareh M, Chanawani M, Khan MA. The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies. BJU Int. 2012;1099(3):367–71.CrossRefGoogle Scholar
  30. 30.
    Pinkstaff DM, Igel TC, Petrou SP, Broderick GA, Wehle MJ, Young PR. Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology. 2005;65(4):735–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Taira AV, Merrick GS, Galbreath RW, Andreini H, Taubenslag W, Curtis R, Butler WM, Adamovich E, Wallner KE. Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting. Prostate Cancer Prostatic Dis. 2010;13(1):71–7.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Onik G, Miessau M, Bostwick DG. Three-dimensional prostate mapping biopsy has a potentially significant impact on prostate cancer management. J Clin Oncol. 2009;27(26):4321–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Ayres BE, Montgomery BS, Barber NJ, Pereira N, Langley SE, Denham P, Bott SR. The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance. BJU Int. 2012;109(8):1170–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Barqawi AB, Rove KO, Gholizadeh S, O’Donnell CI, Koul H, Crawford ED. The role of 3-dimensional mapping biopsy in decision making for treatment of apparent early stage prostate cancer. J Urol. 2011;186(1):80–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Vyas L, Acher P, Kinsella J, Challacombe B, Chang RT, Sturch P, Cahill D, Chandra A, Popert R. Indications, results and safety profile of transperineal sector biopsies [TPSB] of the prostate: a single centre experience of 634 cases. BJU Int. 2014;114(1):32–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Valerio M, Anele C, Freeman A, Jameson C, Singh PB, Hu Y, Emberton M, Ahmed HU. Identifying the index lesion with template prostate mapping biopsies. J Urol. 2015;193:1185. pii: S0022-5347[14]04859-9.CrossRefPubMedGoogle Scholar
  37. 37.
    Onik G, Barzell W. Transperineal 3D mapping biopsy of the prostate: an essential tool in selecting patients for focal prostate cancer therapy. Urol Oncol. 2008;26(5):506–10.CrossRefPubMedGoogle Scholar
  38. 38.
    Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011;186(5):1830–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Minamida S, Satoh T, Tabata K, Kimura M, Tsumura H, Kurosaka S, Matsumoto K, Fujita T, Iwamura M, Baba S. Prevalence of fluoroquinolone-resistant Escherichia coli before and incidence of acute bacterial prostatitis after prostate biopsy. Urology. 2011;78(6):1235–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Batura D, Rao GG, Bo Nielsen P, Charlett A. Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates. BJU Int. 2011;107(5):760–4.CrossRefPubMedGoogle Scholar
  41. 41.
    Mosharafa AA, Torky MH, El Said WM, Meshref A. Rising incidence of acute prostatitis following prostate biopsy: fluoroquinolone resistance and exposure is a significant risk factor. Urology. 2011;78(3):511–4.CrossRefPubMedGoogle Scholar
  42. 42.
    Grummet JP, Weerakoon M, Huang S, Lawrentschuk N, Frydenberg M, Moon DA, O’Reilly M, Murphy D. Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int. 2014;114(3):384–8.PubMedGoogle Scholar
  43. 43.
    Losa A, Gadda GM, Lazzeri M, Lughezzani G, Cardone G, Freschi M, Lista G, Larcher A, Nava LD, Guazzoni G. Complications and quality of life after template-assisted transperineal prostate biopsy in patients eligible for focal therapy. Urology. 2013;81(6):1291–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Merrick GS, Taubenslag W, Andreini H, Brammer S, Butler WM, Adamovich E, Allen Z, Anderson R, Wallner KE. The morbidity of transperineal template-guided prostate mapping biopsy. BJU Int. 2008;101(12):1524–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Buskirk SJ, Pinkstaff DM, Petrou SP, Wehle MJ, Broderick GA, Young PR, Weigand SD, O’Brien PC, Igel TC. Acute urinary retention after transperineal template-guided prostate biopsy. Int J Radiat Oncol Biol Phys. 2004;59(5):1360–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Tsivian M, Abern MR, Qi P, Polascik TJ. Short-term functional outcomes and complications associated with transperineal template prostate mapping biopsy. Urology. 2013;82(1):166–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Nelson N. Stone
    • 1
    • 2
    Email author
  • Vassilios M. Skouteris
    • 3
  • E. David Crawford
    • 4
  1. 1.Department of UrologyThe Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.VailUSA
  3. 3.Prostate Brachytherapy DepartmentHygeia Hospital, Hygeia GroupAthensGreece
  4. 4.Radiation Oncology, University of ColoradoDenver, AuroraUSA

Personalised recommendations