Freehand transperineal prostate biopsy with PrecisionPoint under local anaesthesia: experience of a tertiary referral centre in Malaysia

Abstract Background Transperineal prostate biopsy (TPPBx) under local anaesthesia (LA) has gained momentum in recent years. It is a simple, alternative office procedure to transrectal biopsy of prostate, with higher cancer detection and lower infection rates. This is the first reported transperineal biopsy in Malaysia using PrecisionPoint. We aim to determine clinically significant prostate cancer with TPPBx and its associated complication utilizing this method of biopsy. Methods We retrospectively reviewed medical records of patients who underwent TPPBx between November 2020 and September 2022. Electronic medical system was utilized to review patients’ information, PSA results, mpMRI reports (prostate volume, PI-RADS scoring) and complications experienced. Data were analysed to determine clinically significant prostate cancer (biopsy result with International Society of Urological Pathology (ISUP) grade 2 and above). Local anaesthesia was given through perineal skin infiltration as well as periprostatic nerve block. We performed our procedure using transrectal linear probe with biplane transducer for visual guidance using cognitive fusion. Biopsies were done in accordance with Ginsburg protocol. Ethics approval was obtained from University of Malaya Research Ethics Committee (UMREC) Results Total of 65 patients underwent transperineal biopsy under local anaesthesia from November 2020 to May 2022. All patients had mpMRI prior to the procedure. Prostate cancer was detected in 32 (49.2%) patients regardless of whether they had a previously negative transrectal prostate biopsy. Of the 65 patients, 27 (41.5%) were diagnosed with clinically significant prostate cancer requiring active treatment. The number of patients with clinically significant cancer was highest in the mpMRI reported PI-RADS 5 group with 15 patients (51.7%), followed by PI-RADS 4 group, with 10 patients (38.5%) and the PI-RADS 3 group, with two patients (20%). Complications reported were haematuria (33.8%) and acute urinary retention (6%). There were no reported urinary tract infections or sepsis as well as rectal bleeding after freehand transperineal biopsy of prostate. Conclusion Freehand transperineal biopsy of prostate using PrecisionPoint demonstrated an acceptable cancer detection yield while avoiding significant infection.