Abstract
Objectives
To assess the prostate cancer diagnostic yield, complications, and costs of transperineal
prostate biopsies when performed with local anesthesia versus sedation.
Methods
Data were prospectively collected for men undergoing transperineal MRI-targeted biopsy
at the outpatient clinic and tertiary hospital of a single center between October
2017 to February 2020. These data included demographic, procedural, and pathologic
variables and complications. Time-driven activity-based costing was performed to compare
procedural costs.
Results
126 men were included. Age, BMI and PSA were similar for local (n = 45) vs sedation (n = 81), all P>0.05. Detection of clinically significant prostate cancer (CSPC) on combined systematic
and targeted biopsy was similar for local vs sedation (24% vs 36%; P = 0.2). Local had lower detection on targeted biopsies alone (8.9% vs 25%; P = 0.03). However, fewer targeted cores were obtained per region of interest with
local vs sedation (median 3 vs 4 cores; P<0.01). For local vs sedation, the complication rate was 2.6% and 6.1% (P = 0.6). The median visual analog pain score for local vs sedation was 3/10 vs 0/10
(P<0.01). The mean procedure time for local vs sedation was 22.5 vs 17.5 minutes (48.3
minutes when including anesthesia time). Time-driven activity-based costs for local
vs sedation were $961.64 vs $2208.16 (P<0.01).
Conclusion
Transperineal biopsy with local anesthesia is safe with comparable outcomes to sedation.
While the number of cores taken differed, there was no statistical difference in the
detection of clinically significant cancer.
Abbreviations:
CSPC (Clinically significant prostate cancer), GG (Gleason grade group), mpMRI (Multiparametric magnetic resonance imaging), PI-RADS (Prostate imaging reporting & data system), ROI (Region of interest), TDABC (Time-driven activity-based costing)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 01, 2021
Accepted:
June 21,
2021
Received:
March 24,
2021
Footnotes
Financial Disclosure: Dr. Margolis is an ad-hoc consultant for Blue Earth Diagnostics. Dr. Hu is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. Dr. Salami is a paid consultant for Bayer HealthCare Pharma.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
