Evidence for local anaesthetic transperineal biopsy versus transrectal prostate biopsy

Abstract

### What you need to know Prostate cancer is usually diagnosed using image guided needle biopsy. Approximately 70 000 such biopsies are performed annually in the UK,1 but these numbers have fallen since the widespread introduction of prostate multiparametric magnetic resonance imaging (mpMRI) scanning as a pre-biopsy investigation for men suspected to have prostate cancer.23 Initial suspicion normally arises following blood test results that show a raised level of prostate specific antigen (PSA) and/or an abnormal prostate examination, which are usually undertaken as part of case finding or opportunistic screening.4 However, prostate biopsies are an expensive intervention and have significant side effects for patients, and uncertainty persists on the need for further biopsies in the case of negative results. Over the past three decades, prostate biopsy techniques have been increasingly refined, centring around transrectal ultrasound (TRUS), image guidance of biopsy needle placement, use of pre-biopsy mpMRI, and needle guidance access systems. The past five years have seen a gradual trend away from transrectal biopsy towards local anaesthetic transperineal biopsy (LATP), precipitated primarily by concerns about the infection risk of transrectal biopsy, along with the perceived superiority of transperineal biopsy in targeting mpMRI visible lesions.5 Transperineal access systems have removed the need for either a large fixed …