image by: Dr Roger Urologist

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New biopsy technique found to improve prostate cancer detection

Prostate cancer is the most common cancer in the developed world. The most widely used method of diagnosing prostate cancer involves a biopsy that passes a needle through the lining of the lower bowel (the rectum) and into the prostate gland, which is performed under local anaesthetic. This is called the transrectal route. Researchers and doctors have been looking for ways to improve the needle biopsy process, largely due to the concern of infections from the biopsy process. One option has been to change the route through which the needle passes into the prostate, which would be for it to go through the skin instead of the bowel lining.

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Featured

  PrecisionPoint

“I tell everyone I know who needs a biopsy: You don’t want the transrectal biopsy, you want the best that is available. Due to its safety and effectiveness, this state-of-the-art approach is being rapidly adopted around the world. The PrecisionPoint® Transperineal Access System (PPTAS) is the first FDA cleared device allowing free-handed transperineal biopsy of the prostate. The device and technique eliminate the need for bowel prep and antibiotics prior to the prostate biopsy. The procedure allows access to the prostate through the perineum or “taint”, avoiding the rectum completely. The procedure takes 15-20 minutes and can be performed under local or twilight anesthesia.

  Recent Advances and Current Role of Transperineal Prostate Biopsy

At the present time, prostate biopsy is most commonly performed via a transrectal (TR) approach using ultrasound guidance. In recent years, multiparametric MRI has been shown to greatly improve the detection of clinically significant prostate cancer. As a result, multiple biopsy platforms have been developed that allow for the fusion of MRI and live transrectal ultrasound images to augment the user’s ability to detect prostate cancer. Although these advancements have improved accuracy, use of TR prostate biopsy is associated with a high risk of infectious complications. Thus, in recent years there has been growing interest in performing prostate biopsies percutaneously via a transperineal approach (TP), thereby avoiding rectal bacteria.

Previously Featured

There Is No Longer a Role for Systematic Biopsies in Prostate Cancer Diagnosis

Systematic transrectal ultrasound-guided (TRUS) biopsy, the mainstay of prostate cancer diagnosis for the past 30 yr, is associated with errors leading to clinically significant cancers being missed and overdetection of clinically insignificant cancer that might not benefit from treatment but can lead to overtreatment-related harms.

Comparison of Targeted vs Systematic Prostate Biopsy in Men Who Are Biopsy Naive

The value of magnetic resonance imaging (MRI)–guided prostate biopsy, performed via MRI and ultrasonography fusion, has been confirmed in large prospective studies, and endorsement of its use in the repeated biopsy setting has come from both urological and radiological organizations.5 Despite advances, the optimal method for use of MRI-guided biopsy is not yet clear.

Do men regret prostate biopsy: Results from the PiCTure study

Prostate biopsy is an invasive test that involves rectal insertion of an ultrasound probe to diagnose cancer of the prostate. It is usually prompted by a raised Prostate Specific Antigen (PSA), prostatic symptoms, an abnormal digital rectal examination (DRE) or a combination of these.

Fusion MRI/Ultrasound-Guided Transperineal Biopsy: A Game Changer in Prostate Cancer Diagnosis

Multiparametric-Magnetic Resonance Imaging(mp-MRI) presents the ability to detect clinically significant cancer, aiming to avoid biopsy if the results are negative or target an abnormal lesion if a suspected lesion of the prostate is found. Recent guidelines recommend the performance of 12 standard biopsies along with 3 to 5 targeted biopsies in suspected prostate lesions, depending on the size of the prostate lesion. In addition, prostate biopsy can be performed by either the transperineal or the transrectal approach. The aim of this comprehensive review is to highlight the role of both standard and targeted MRI/Ultrasound (US) fusion transperineal biopsy (TPB) in the diagnostic approach of prostate cancer cases, to report its diagnostic efficacy and complication rates and to suggest the promising usage of MRI/US fusion TPB in the future.

How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer?

The most accurate way to detect cancer cells inside the prostate gland is the surgical removal and histopathological examination of the entire gland. As this approach is clinically inapplicable to each patient with suspicious findings, prostate biopsy is accepted as the best diagnostic technique to detect prostate cancer.

How to make your prostate biopsy go better-before, during, and after

Most men do not find prostate biopsy excessively painful or uncomfortable, and the complications are usually not serious—but can be. Certain steps taken before, during, and after the procedure can improve the outcome:

The Problem with Systematic Prostate Biopsy

When prostate cancer is suspected, a biopsy is needed to confirm?or rule out?a cancer diagnosis. During a biopsy, a needle is inserted into the prostate gland through the wall of the rectum. A small amount of tissue is removed and sent to a laboratory for further evaluation. The vast majority of prostate biopsies are trans-rectal ultrasound (TRUS) biopsies. Unfortunately, these are imprecise and expose men to an assortment of unpleasant side effects including infection, rectal bleeding, urinary problems (frequent urination, weak or slow stream or dribbling urine) and sexual dysfunction. A typical TRUS biopsy only samples tissue from 1% of the prostate gland.

Think Twice Before a Prostate Biopsy: The Evidence You Need to Hear

In this episode, Dr. Stephen Petteruti reveals why these procedures may lead to unnecessary treatments, complications, and even the spread of cancer cells. Many prostate cancers are non-aggressive and never become life-threatening—so why take the risk? Discover safer, evidence-based strategies for monitoring your prostate health without invasive procedures. Don't let fear make the decision for you—get the facts and take control of your health with confidence.

“TREXIT 2020”: why the time to abandon transrectal prostate biopsy starts now

Despite the recent advances in prostate cancer imaging with MRI [4] and PSMA PET, a biopsy is still required to establish a diagnosis of prostate cancer. The vast majority of prostate biopsies are still performed using the TR approach—over 2 million per year in Europe and North America alone. However, in recent years TP biopsy has gained increasing favour due to its avoidance of rectal flora.

Resources

Perineologic

With the adoption of active surveillance, we became extremely concerned with the high likelihood of infections and missed cancers resulting from the current standard of care. There was no existing solution that adequately addressed our concerns so we set out to create a safer and more accurate method for performing the prostate biopsy as well as a device to enable urologists to make the transition to the improved transperineal approach. After four years of development, the PrecisionPoint® Transperineal Access System, from Perineologic®, is facilitating this transition.

MRI Fusion Biopsy

During the ultrasound fused biopsy, you'll receive light sedation and be positioned on your side so the doctor can easily access your prostate to take targeted tissue samples. These are located by superimposing your original MRI images over the live ultrasound images, to accurately guide the urologist to areas identified as suspicious. Tissue samples are precisely taken from these areas and sometimes additional areas of your prostate. You'll be taken to a recovery area after the procedure, then discharged when you're ready with someone who can drive you home.