Recent Advances in Systematic and Targeted Prostate Biopsies

Konstantinos Devetzis,1 Francesca Kum,1,2 Richard Popert2 1King’s College School of Medicine, London, UK; 2Department of Urology, 1st Floor Southwark Wing, Guy’s Hospital, London, SE1 9RT, UKCorrespondence: Richard PopertDepartment of Urology, 1 st Floor Southwark Wing, Guy’s Hospital, St Thomas’ St...

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Autores principales:	Devetzis K, Kum F, Popert R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	transperineal transrectal local anaesthetic prostate biopsies covid-19 Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/5a70b4beb59d4e7a87c3c49bffbf4de5
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spelling	oai:doaj.org-article:5a70b4beb59d4e7a87c3c49bffbf4de52021-11-14T19:00:30ZRecent Advances in Systematic and Targeted Prostate Biopsies2253-2447https://doaj.org/article/5a70b4beb59d4e7a87c3c49bffbf4de52021-11-01T00:00:00Zhttps://www.dovepress.com/recent-advances-in-systematic-and-targeted-prostate-biopsies-peer-reviewed-fulltext-article-RRUhttps://doaj.org/toc/2253-2447Konstantinos Devetzis,1 Francesca Kum,1,2 Richard Popert2 1King’s College School of Medicine, London, UK; 2Department of Urology, 1st Floor Southwark Wing, Guy’s Hospital, London, SE1 9RT, UKCorrespondence: Richard PopertDepartment of Urology, 1 st Floor Southwark Wing, Guy’s Hospital, St Thomas’ St, London, SE1 9RT, UKTel +44 2071887188Email rick.popert@gstt.nhs.ukAbstract: Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.Keywords: transperineal, transrectal, local anaesthetic, prostate biopsies, Covid-19Devetzis KKum FPopert RDove Medical Pressarticletransperinealtransrectallocal anaestheticprostate biopsiescovid-19Diseases of the genitourinary system. UrologyRC870-923ENResearch and Reports in Urology, Vol Volume 13, Pp 799-809 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	transperineal transrectal local anaesthetic prostate biopsies covid-19 Diseases of the genitourinary system. Urology RC870-923
spellingShingle	transperineal transrectal local anaesthetic prostate biopsies covid-19 Diseases of the genitourinary system. Urology RC870-923 Devetzis K Kum F Popert R Recent Advances in Systematic and Targeted Prostate Biopsies
description	Konstantinos Devetzis,1 Francesca Kum,1,2 Richard Popert2 1King’s College School of Medicine, London, UK; 2Department of Urology, 1st Floor Southwark Wing, Guy’s Hospital, London, SE1 9RT, UKCorrespondence: Richard PopertDepartment of Urology, 1 st Floor Southwark Wing, Guy’s Hospital, St Thomas’ St, London, SE1 9RT, UKTel +44 2071887188Email rick.popert@gstt.nhs.ukAbstract: Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.Keywords: transperineal, transrectal, local anaesthetic, prostate biopsies, Covid-19
format	article
author	Devetzis K Kum F Popert R
author_facet	Devetzis K Kum F Popert R
author_sort	Devetzis K
title	Recent Advances in Systematic and Targeted Prostate Biopsies
title_short	Recent Advances in Systematic and Targeted Prostate Biopsies
title_full	Recent Advances in Systematic and Targeted Prostate Biopsies
title_fullStr	Recent Advances in Systematic and Targeted Prostate Biopsies
title_full_unstemmed	Recent Advances in Systematic and Targeted Prostate Biopsies
title_sort	recent advances in systematic and targeted prostate biopsies
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/5a70b4beb59d4e7a87c3c49bffbf4de5
work_keys_str_mv	AT devetzisk recentadvancesinsystematicandtargetedprostatebiopsies AT kumf recentadvancesinsystematicandtargetedprostatebiopsies AT popertr recentadvancesinsystematicandtargetedprostatebiopsies
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Recent Advances in Systematic and Targeted Prostate Biopsies

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