Local anaesthetic trans-perineal biopsy of the prostate for patients with no rectum

Abstract

Objective:

To report our experience of transperineal needle biopsy of the prostate under transperineal ultrasound guidance in patients with no rectum.

Materials and Methods:

Six patients with previous surgical removal of rectum were managed at our centre between December 2021 and July 2023. An initial magnetic resonance imaging (MRI) of the prostate was performed to identify target areas. Patients were placed in the lithotomy position. Local anaesthetic was injected into the skin and deep close to the prostate neurovascular bundle using transperineal ultrasound guidance. A transabdominal curvilinear ultrasound probe was used to locate the prostate. A Co-axial needle was used to pass the biopsy needle through the skin into the prostate to take multiple biopsies using a saturation Ginsburg protocol.

Results:

Prostate cancer was diagnosed in three of the six patients (50%). All patients had clinically significant prostate cancer, i.e. Grade group ≥ 2. The median recorded pain score was 1 (range 0–4). A total of 92 cores were taken from six patients included. Only five of them had no prostate tissue in it. No short-term complications were noted on a median follow-up of 17.6 months (7–28 months).

Conclusion:

Prostate biopsy in patients with previous abdominoperineal resection of the rectum is feasible using a percutaneous ultrasound-guided freehand approach via the perineum with acceptable diagnostic yield. The procedure can be performed under local anaesthetic instead of other reported techniques which require a general anaesthetic.

Level of evidence:

Not applicable