Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis

OBJECTIVES

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.

PATIENTS AND METHODS

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).

RESULTS

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'.

CONCLUSION

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.

Recent advances in treatment for Benign Prostatic Hyperplasia

Clinical benign prostatic hyperplasia (BPH), often identified as a worsening ability of a male to pass urine, is a significant problem for men in our society. In 2015, the use of personalised medicine is tailoring treatment to individual patient needs and to genetic characteristics. Technological advances in surgical treatment are changing the way BPH is treated and are resulting in less morbidity. The future of BPH treatments is exciting, and a number of novel techniques are currently under clinical trial.

PSA screening in New Zealand: total population results and general practitioners' current attitudes and practices

AIMS

Prostate cancer is the second most common cancer among men in New Zealand. Prostate-specific antigen (PSA) as a screening tool for prostate cancer remains controversial. The aim was to determine the rate of PSA screening in New Zealand and to survey general practitioners' utility of PSA and their attitudes towards PSA screening.

METHOD

A questionnaire was sent to 1000 general practitioners (GPs). In addition, a non-identifiable prospective audit of all registered New Zealand GPs' laboratory PSA tests was accessed for 2011.

RESULTS

Of the 931,923 males older than 40 years, 267,037 had a PSA test performed (28.3%). This percentage peaked in the 65-75 age group (45%). 263 GP questionnaires were completed. 79% of all GPs would initiate discussion of PSA testing. The most common method of testing was at a time of another health need or check-up.

CONCLUSION

The incidence of yearly PSA testing in the New Zealand male population over the age of 40 is 28%. GPs provide appropriate information for men to make an informed decision about PSA screening. There is an increasing population of GPs who will not initiate any discussion of PSA testing in their male patients.

Workload in a provincial New Zealand vascular surgery service

AIM

There is increasing evidence that centralising complex surgical procedures improves mortality rates. The focus on mortality as the primary outcome measure overlooks every other aspect of a local surgical service that could be lost by centralisation. The aim of this audit was to assess the total vascular service provided in a provincial vascular surgical unit

METHOD

This was a 12-month prospective audit of the vascular surgical service in Taranaki. All outpatient and inpatient vascular consultations and procedures carried out by a surgeon or interventional radiologist were identified.

RESULTS

There were 181 inpatient admissions of which 121 (67%) were elective and 60 (33%) acute. There were 41 (29%) non-operative admissions, while 140 (71%) required an operation as an inpatient. There were 967 total bed days for vascular patients with an average stay of 5 days (4-6 95% CI). There were 588 vascular outpatient consultations for 396 patients. There were 201 (34%) new patient visits and 387 (66%) follow up appointments.

CONCLUSION

Although the number of operations performed per population per year in Taranaki over the audit period was consistent with other reports, the number of major vascular cases did not meet suggested annual thresholds for minimising mortality. Despite this there was no evidence of increased mortality in any group. There was a large amount of non operative work which is not considered when focus is exclusively on mortality.