Transperineal Prostate Biopsy under Local Anaesthetic

APC recently undertook a pilot study to determine the safety and tolerability of transperineal prostate biopsy (TPBx) under local anaesthetic (LA) in an outpatient setting at APC with 43 men providing consent to participate in the pilot study. TPBx are routinely done internationally in large cancer centres. This reduces the impact on public hospitals ie wait times, increased efficiency.

The procedure was performed by a urologist with nursing support. The nurse educated the patients pre-operatively on the procedure and also provided written information. Patients completed a questionnaire post-biopsy with a numerical pain rating (NPRS) for pain (0=no pain; 10=worst pain), whether they had a biopsy before, and if they would opt to have the procedure again under LA. Patient demographics, reason for biopsy and any adverse events were also recorded.

• 95% of men were able to complete the procedure. 5% were unable to tolerate the procedure and were referred for TPBx under general anaesthetic (GA).
• Mean average of patients was 66 years.
• 5% of patients experienced adverse events (vasovagal) - both cases were managed in the outpatient setting by the urologist and nurse and discharged safely.
• Maximum pain scores varied on the NPRS from 0/10 to 6.5/10. 97% of patients reported they would have a repeat biopsy under LA.
• Of the 10 patients who had a previous prostate biopsy under GA, 9/10 reported they would repeat the procedure under LA.
• 17% of patients required biopsy due to being on active surveillance.
• 80% of patients had a positive diagnosis.

Nursing support facilitated adequate education for patients prior to the procedure and supportive care during the biopsy and recovery period. This allows for continuity of care.

This preliminary data suggests that men undergoing TPBx under LA in an outpatient setting suffer few side effects and tolerate the procedure well.