Antibiotic free Local Anaesthetic Transperineal Prostate (LATP) biopsies: A review of the first 750 cases

Introduction: A predominantly nurse-performed LATP service using PrecisionPoint was newly started in July 2019. Initial indications were repeat biopsy, anterior lesions, and AS patients. Service was expanded in March 2020 to all prostate pathway patients according to BAUS COVID guidance. Methods: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD >0.15. PIRADS 3-5 lesions were targeted with 3 cores (sent separately). Systematic Ginsburg protocol biopsies were also performed (each zone sent separately). Tamsulosin was started for BOO patients. No antibiotics were used unless immunocompromised or previous sepsis. A prospective database at point of care was created detailing patient information, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. Results: 750 consecutive patients analysed. Detection of significant cancer (Gl3+4) in PIRAD1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected significant cancer in 36%, systematic plus targeted achieved 63%. Of AS patients;40% with Gl3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl4+3. 5 experienced vasovagal episodes. Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further repeat biopsies (89%). Conclusion: We have set up a safe, effective, antibiotic free LATP biopsy service, with high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.