Why Transition to Transperineal Prostate Biopsies?
Prostate cancer remains one of the most common cancers among men - with early detection proving critical for improving outcomes, and prostate biopsies representing a fundamental method for ensuring accurate diagnoses. While transrectal biopsies (TRBx) have long been recognized as the most widely used method, transperineal biopsies (TPBx) are becoming increasingly utilized for what many see as significant benefits.
In this article, we’ll dig into several of these benefits – including infection-control, cost-savings, and overall convenience - while also highlighting why, exactly, the transperineal approach is becoming the preferred choice of prostate biopsy for clinicians worldwide.
The Evolving Landscape of Prostate Biopsies
Prostate biopsies are essential for diagnosing prostate cancer, involving the extraction of small tissue samples for pathological analysis. Traditionally, the transrectal biopsy (TRBx) has been the standard approach; however, due to its higher risk of infection and other complications, there is growing interest in the transperineal biopsy (TPBx), which provides a safer alternative. 1
Comparing Transrectal and Transperineal Approaches
Transrectal Biopsy Overview
The transrectal approach involves passing a biopsy needle through the rectal wall into the prostate. 2 While this method is convenient and widely implemented, certain challenges inherent to the procedure have prompted a shift toward alternative methods.
Advantages of TRBx:
The transperineal approach involves inserting the needle through the perineum (the area between the anus and scrotum). Unlike TRBx, TPBx avoids the rectal wall, creating a cleaner pathway to the prostate. 4
Advantages of TPBx:
The Role of Advanced Technology
Innovative tools like the TP Pivot Pro have further enhanced the efficiency of TPBx procedures by:
The shift from transrectal to transperineal biopsies is gaining momentum as more healthcare providers prioritize patient safety and diagnostic accuracy. With its improved safety profile, lower complication rates, and enhanced cancer detection capabilities, TPBx is quickly becoming the gold standard for prostate cancer diagnosis.
For clinics and healthcare providers ready to make the transition, investing in education and technology, such as CIVCO’s TP Pivot Pro, is a critical step in leading this change and improving patient outcomes.
References:
In this article, we’ll dig into several of these benefits – including infection-control, cost-savings, and overall convenience - while also highlighting why, exactly, the transperineal approach is becoming the preferred choice of prostate biopsy for clinicians worldwide.
The Evolving Landscape of Prostate Biopsies
Prostate biopsies are essential for diagnosing prostate cancer, involving the extraction of small tissue samples for pathological analysis. Traditionally, the transrectal biopsy (TRBx) has been the standard approach; however, due to its higher risk of infection and other complications, there is growing interest in the transperineal biopsy (TPBx), which provides a safer alternative. 1
Comparing Transrectal and Transperineal ApproachesTransrectal Biopsy Overview
The transrectal approach involves passing a biopsy needle through the rectal wall into the prostate. 2 While this method is convenient and widely implemented, certain challenges inherent to the procedure have prompted a shift toward alternative methods.
Advantages of TRBx:
- Cost-Effectiveness: TRBx requires fewer specialized tools and personnel compared to alternative methods. 1
- Established Technique: TRBx has been the most common biopsy method for decades, ensuring familiarity among many practitioners. 1
- Higher Infection Rates: Passing the needle through the rectal wall increases exposure to fecal bacteria, posing a severe sepsis risk (up to 3.5%). 3
- Restricted Sampling Access: TRBx biopsies often fail to adequately sample critical areas of the prostate, such as the apical and anterior regions—zones where cancer is frequently missed—resulting in a higher likelihood of underdiagnosis and reduced prostate cancer detection. 2 4 6
The transperineal approach involves inserting the needle through the perineum (the area between the anus and scrotum). Unlike TRBx, TPBx avoids the rectal wall, creating a cleaner pathway to the prostate. 4
Advantages of TPBx:
- Lower Infection Risk: With the use of pre-procedure antibiotics, TPBx is associated with a nearly zero risk of sepsis, as it avoids rectal bacteria altogether, allowing for a sterile procedure and reducing the need for antibiotics. 5
- Enhanced Precision: The transperineal route provides better access to hard-to-reach areas of the prostate, such as the anterior and apical regions, areas where cancer are often undersampled during transrectal procedures. 6
- Reduced Bleeding: By bypassing the rectal wall, TPBx reduces the likelihood of rectal bleeding post-procedure. 2
- Flexible Anesthesia Options: TPBx can be performed under local anesthesia, allowing for procedures to be performed in-office in a manner that achieves both excellent patient tolerability and complication minimization. 7
- Initial Learning Curve: Many clinicians are unfamiliar with TPBx and would therefore need to undergo adequate training before performing.
- Specialized Equipment: A disadvantage of transperineal biopsies is that they often require specialized equipment and setup, which may not be readily available in all clinical settings. 1
The Role of Advanced TechnologyInnovative tools like the TP Pivot Pro have further enhanced the efficiency of TPBx procedures by:
- Reducing puncture sites.
- Maintaining visualization for needle guidance.
- Improving clinician workflow, thanks to easy height adjustments and additional angling options.
The shift from transrectal to transperineal biopsies is gaining momentum as more healthcare providers prioritize patient safety and diagnostic accuracy. With its improved safety profile, lower complication rates, and enhanced cancer detection capabilities, TPBx is quickly becoming the gold standard for prostate cancer diagnosis.
For clinics and healthcare providers ready to make the transition, investing in education and technology, such as CIVCO’s TP Pivot Pro, is a critical step in leading this change and improving patient outcomes.
References:
- Grummet, J., Pepdjonovic, L., Huang, S., Anderson, E., & Hadaschik, B. (2017). Transperineal vs. transrectal biopsy in MRI targeting. Translational Andrology and Urology, 6(3), 368–375. doi: 10.21037/tau.2017.03.58 ↩︎
- Mayo Clinic: Ultrasound-guided transperineal prostate biopsy
- Shahait M, Degheili J, El-Merhi F, Tamim H, Nasr R. Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon. International braz j urol : official journal of the Brazilian Society of Urology. 2016;42(1):60-68. doi:10.1590/S1677-5538.IBJU.2014.0607
- Focal Healthcare: “Transrectal vs. Transperineal Approach for Prostate Biopsy.”
- Rafiq M, Gabriel M, Reddy U, Rochester M, Farag F. Sepsis rates after template prostate biopsy with single-dose prophylactic antibiotic. Central European Journal of Urology. 2022;75(2):205-208. doi:10.5173/ceju.2022.0229
- Ortner G, Tzanaki E, Rai BP, Nagele U, Tokas T. Transperineal prostate biopsy: The modern gold standard to prostate cancer diagnosis. Turkish journal of urology. 2021;47(Supp. 1):S19-S26. doi:10.5152/tud.2020.20358
- Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H. Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible. ANZ journal of surgery. 2022;92(6):1480-1485. doi:10.1111/ans.17593
