David Chen, MD, FACS

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A New Biopsy Technique to Diagnose Prostate Cancer and Reduce Risks of Infections

 

Each year, over 1 million men undergo prostate biopsies to diagnose or rule out prostate cancer. For these men who need a biopsy, there is now an alternative approach that is safer, with significantly lower risks of infection, and potentially higher rate of tumor detection. 

While most prostate biopsies are performed through the rectum (transrectal), there is a means to obtain prostate tissue samples through  the perineum using an external entry point at the skin. The technique, known as transperineal biopsy, is now offered to men who are good candidates for this approach. In this modification of the standard transrectal approach, doctors take samples of the prostate tissue through needles directed through the perineum, the area of skin located between the rectum and the base of the scrotum.

In contrast to the transrectal approach, which typically involves 12 or more separate needle punctures from inside the rectum, a specially designed device used with the transperineal approach limits the number of biopsy needle insertion points to two -  one for each side of the prostate. This further reduces the chance of infection and other side effects.

Fox Chase Cancer Center’s urologic oncologist group has expertise in transperineal biopsy techniques and recently began offering this alternative procedure to patients.

“We are always looking for ways to improve our results, including with the diagnosis of prostate cancer. And that is what we've done with the transperineal approach,” Chen says. “While the standard transrectal approach remains an effective and well-accepted technique, improvement in imaging technology through ultrasounds and MRIs has allowed us to ask whether there was another way that we may offer patients an advantage.”

The procedure for the transperineal biopsy is quite different from that of the transrectal approach - which uses a local anesthetic and is performed in a physician’s office. The transperineal biopsy is performed as an outpatient procedure, in an operating room with the use of anesthesia. The use of more than local anesthetic ensures that the patient will remain still during the procedure and ultimately remain more comfortable.  An ultrasound probe is inserted into the rectum to allow imaging of the prostate, and the Precisionpoint ™ guide enables samples to be taken from each side through only two primary skin puncture sites. The surgeon is then able to take a distribution of samples from throughout the prostate, including access to the anterior (front) and apical (top) regions of the prostate.

Advantages of a transperineal approach:

  • Reduced risk of infection.
  • Reduced risk of procedure-related bleeding.
  • Increased chance for detecting cancers, particularly in the anterior of the prostate.
  • It’s a viable option for patients who would prefer to be under a greater level of sedation or  anesthesia during the biopsy to decrease anxiety.

After biopsy samples are taken, pathologists look for several different cancer-related cell patterns under a microscope. The Gleason Grading System is used along with PSA level and volume (amount of cancerous tissue detected within the core of the biopsy) when evaluating a man with prostate cancer, in order to assess the potential aggressiveness of the cancer and assist in treatment options.

Fox Chase pathologists have extensive experience in diagnosing prostate cancers, especially in early disease when benign tumors can be mistaken for cancer and vice versa.

Who is a good candidate for transperineal biopsy?

Patients who are on “active surveillance” for a slow-growing prostate cancer and are expected to need repeated biopsies
Patients with high PSA scores whose previous standard transrectal biopsies did not detect cancer (which may be a false-negative).
Patients suspected to have tumors in the anterior or apical  areas of the prostate.
Patients with anxiety who may benefit from a greater level of anesthesia and sedation during the prostate biopsy procedure.

Have more questions about prostate biopsies?

If you have been told you need a prostate biopsy and want to know more about transperineal biopsies, call 888-FOX-CHASE (888-369-2427), or request an appointment online.

Learn more about the Prostate Cancer Program at Fox Chase Cancer Center.