A systematic review on the outcomes of local anaesthetic transperineal prostate biopsy.

Abstract

Prostate biopsy plays an important role in prostate cancer diagnosis, however there is currently a lack of standardisation in biopsy approach. Local anaesthetic transperineal biopsy is one available technique and has garnered interest as it avoids the contaminated rectal passage, and encumbrance of general anaesthesia. This systematic review of the literature assessed the diagnostic ability, complication rate, patient tolerability, and cost of local anaesthetic transperineal prostate biopsy. Medline, The Cochrane Library, and Embase were searched for publications on local anaesthetic transperineal prostate biopsy up to March 2021 by two reviewers. Outcomes of interest included cancer detection rates, complication rates, pain assessments and cost. A total of 35 publications with 113,944 men were included in this review. The cancer detection rate for LA transperineal prostate biopsy in patients undergoing primary biopsy was 52% [95% CI 0.45-0.60, I2 =97] and the clinically significant cancer detection rate (Gleason≥3+4) was 37% [95% CI 0.24-0.52, I2 =99%]. The rate of infection-related complications in the included studies was 0.15% [95% CI 0.0000-0.0043, I2 =86]. The LA transperineal procedures had a low rate of procedural abandonment (26/6954, 0.37%) with the greatest pain scores measured during local anaesthetic administration. No formal cost analyses on local anaesthetic transperineal prostate biopsies were identified in the literature. The overall risk of bias in the included studies was high with considerable study heterogeneity and publication bias. Transperineal prostate biopsy performed under local anaesthesia is a viable option for centres interested in avoiding the risk of infection associated with transrectal biopsy, and the logistical burden of general anaesthesia. further investigation into local anaesthetic transperineal prostate biopsy with comparative studies is warranted for its consideration as the standard in prostate biopsy technique.