TRANSPERINEAL TEMPLATE-GUIDED SATURATION PROSTATE BIOPSIES

High-risk prostate cancer represents a therapeutic challenge for both the urologist and radiation oncologist. Patients with prostate cancer used to be diagnosed prior to the PSA era frequently on transurethral resection of the prostate gland. When prostate specific antigen (PSA) came into use for screening prostate cancer patients in the late 1980s, we began seeing more and more patients with early prostate cancer that began to be found on transrectal ultrasound-guided needle biopsies. In practice, many urologists are seeing patients with elevated PSAs who have undergone one or more transrectal ultrasound-guided needle biopsies that have shown no evidence of cancer, yet the clinician is still concerned that a geographic missed may have occurred and there still may be cancer residing within the prostate gland. For a more thorough evaluation of the prostate gland, mapping techniques such as utilizing saturation biopsies have been performed.

Initially with sextant-based biopsies in the late 1980s, there was a false negative of 30%. With sextant biopsies and biopsy of the lateral lobe of the prostate, cancer detection rates increased by 23%. The most common, non-sextant site for cancer of the prostate gland is in the anterior horn. Extended prostate biopsies increase cancer detection rates by over 40%. Prostate saturation biopsies may increase the accuracy of diagnosis and yields have been on the order of 15-35% in prostate cancer patients with prior negative biopsies. Transperineal interstitial guided prostate biopsies have the advantage of improved accuracy and precision and increased access to the anterior and apical regions with detailed mapping. It is necessary, however to do this procedure in a certified prostate cancer clinic under anesthesia. The equipment used for transperineal prostate saturation biopsies is the same equipment utilized for transperineal interstitial seed implantation. Consequently, Dr. Echt has been asked by numerous urologists from various prostate cancer clinics to do their saturation biopsies for them. We utilize a mapping technique of 8 biopsies at the base, 10 in the mid gland, and 6 in the apex, and then perform a few other biopsies in other regions if we feel that there will be yield. The procedure typically takes approximately 20 minutes to accomplish. Patients typically go to the recovery area in the ambulatory surgery center where the biopsy is performed and are discharged to home within an hour. They see their urologist back one week thereafter with the pathology results at that time and a diagnosis given to the patient.

Gregory A. Echt, MD
GAE/jcc

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