Transperineal prostate biopsy under local anesthesia

Transperineal approach is now recommended by international guidelines for performing prostate biopsies¹. The reasons are numerous: less infection rate, same approach from diagnosis to treatment, less invasive procedure… This approach can be performed under local or general anesthesia, allowing physicians to adapt the exam to each patient. Once again, each option has advantages and disadvantages. This is the subject of this new article.

Technique of Transperineal prostate biopsy under local anesthesia: the periprostatic nerve block

This technique has been studied during many years by a lot of physicians. Today, this technique is approved as a safe and an efficient technique. This allows the physician to perform it in an operating room (OA) or in office. This is crucial for a lot of centers that are not equipped with OA or don’t have access to it.

In a concrete way, the anesthesia should be done under ultrasound guidance, after good skin anesthesia. This is very important to secure the patient and to improve his comfort. This is crucial because the main problem with transperineal prostate biopsy is the pain. Thanks to the studies and advancements in urology, we can say now that this technique (transperineal prostate biopsy under local anesthesia) is safe, feasible, pain-free and efficient².

It is important to add that performing prostate biopsy under general or local anesthesia allows physicians to offer personal care to their patients. If they are eligible to local anesthesia, it is less invasive for them, for those who prefer. But it could be more secure for other to have general anesthesia. The patient is now part of his care and physicians can offer several options with this technique.

Transperineal approach: biopsy standard for prostate cancer

Since 2021, European guidelines have evolved and recommend now to perform prostate biopsy by the transperineal way³. That means that more physicians will follow the guidelines to provide the best care possible to their patients.

Concerning American guidelines, it is not yet recommended to perform transperineal prostate biopsy, but physicians are practicing evidence-based medicine, and many studies show the evidence, so it will certainly become the standard of care.

Concerning the type of anesthesia, it depends on the practice, the patient, the material and the available ressources. But the fact that transperineal prostate biopsy under local anesthesia is feasible and safe brings more options to doctors and patients.

It is important to notice that patients are more and more informed about their disease and their care journey. Sometimes, when they see something new, they are ready to try and to find a physician who perform new techniques or who offer several options. And this phenomenon is growing with Internet, with more educational content. Physicians should be ready to meet these “new” expectations.

Sources :

Podcast de Dr Anract (https://open.spotify.com/episode/5NyuiNsHGnnUnUHykZVZLH?si=EkW35PEGQa2v3tORdC7dEA)
¹ https://uroweb.org/guidelines/prostate-cancer/chapter/diagnostic-evaluation
² https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Transperineal%20biopsies.pdf
³ https://uroweb.org/guidelines/urological-infections/summary-of-changes/2021