Background/significance: 

Introduction: TRUS biopsies are associated with high false-negatives, sepsis and other complications. The Transperineal Biopsy (TPB) with a template grid provides systematic sampling of the entire prostate including anterior and transition zones. Sepsis rates of TPB in the literature are negligible.

Objectives: To review the impact of TPB at our institution by assessing rates of cancer detection and grading, treatment outcomes and complication rates.

Methods: A review of data was performed for all patients who underwent TPB between 2009 and 2013. Variables included reason for TPB, age, PSA, relevant previous histological diagnosis, TPB histology, and ongoing management plan.

Results: 110 patients underwent 111 TPBs at our institution between September 2009 and March 2013. On average, 22 cores were taken from each procedure.

Disease upgrade occurred in 37.5% of Active Surveillance patients (15/40), 35% of patients with Previous-Negative-TRUS (19/ 53), and 58.8% in patients undergoing TPB for Other Reasons (10/17). Of these patients, anterior and/or transition zones were involved in 66%, 79% and 80%, respectively. Involvement in anterior and/or transition zones only occurred in 40%, 37% and 10%, respectively.

Of 44 patients who received disease upgrading overall, 77% underwent treatment with curative intent.

Complications included a 6.3% (n=7) rate of Acute Urinary Retention and 2.7% (n=3) of Clot Retention. There were no episodes of Urosepsis.

Conclusion: TPB at The Alfred showed a high rate of disease upgrading, with a large proportion involving anterior and transition zones. As a result, a significant amount of patients went on to receive curative treatment.

The Transperineal Template Biopsy is a valuable diagnostic procedure with minimal risk of developing urosepsis. We believe this procedure should be offered as an option for all repeat prostate biopsies.

As a result of our analysis, patients at our institution are now prescribed perioperative Tamsulosin.