What procedures are being used?

The methods most commonly used to obtain prostate biopsies for possible PCa are called:

  • A Transrectal biopsy – known as a TRUS – this is where a needle is inserted into the prostate gland through an ultrasound imaging probe placed in the rectum (back passage). The ultrasound scan uses sound waves to give the doctors a view of the prostate gland whilst doing the biopsy, and a needle is used to take prostate tissue biopsy samples.
  • A Transperineal biopsy – known as a TP – this is where the biopsy needle is passed directly through the skin (perineum) between the anus and the scrotum in order to take prostate tissue biopsy samples. An ultrasound probe is placed in the rectum in order to visualise the prostate gland, but instead of the needle passing up the ultrasound probe and through the wall of the rectum, it passes directly through the skin of the perineum.

TP biopsies have historically been performed under general anaesthetic (GA) where patients are put to sleep – however, this is an involved procedure requiring day case surgery, with the associated risks of a GA. A recent medical advance has been to perform the TP biopsy procedure under a local anaesthetic (LA) – termed an LATP biopsy –where the skin of the perineum and deeper area around the prostate is numbed.  In the TRANSLATE trial the LATP biopsy is being directly compared against longstanding TRUS biopsy, in terms of detection of clinically significant PCa (i.e. cases of PCa that are likely to require treatment), and in terms of complications and costs of the procedure.

 

Clinical descriptions of procedures being used

1. LATP biopsy

This should be performed with an average of 12 systematic biopsy cores in 6 sectors (i.e. x2 biopsy cores per anterior, mid, and posterior gland sector, left and right-sided) depending on prostate size, using the “Precision-Point” access system, or the BK UA1232 device.

An additional 4 target biopsy cores will be taken for each significant target lesion seen on the pre-biopsy MRI.

The LATP biopsy should ideally be performed in the outpatient setting with the patient reclined in the Lloyd-Davis / lithotomy position, using LA infiltration of the perineum, and should be performed without antibiotics.

Each centre will use its existing LATP biopsy technique in order to reflect “real world” clinical practice (given that there are some minor variances in LATP biopsy technique from centre to centre already using this technique across the UK).

 

2. TRUS biopsy

This should be performed with an average of 12 systematic biopsy cores (i.e. x2 biopsy cores per base, mid, and apical regions of the prostate gland, left and right-sided) depending on prostate size, using a TRUS probe.

An additional 4 target biopsy cores will be taken for each significant target lesion seen on the pre-biopsy MRI.

The TRUS biopsy should be performed ideally in the outpatient setting with the patient in the left lateral position, using LA infiltration of the prostate, and will be performed with a pre-procedure dose of antibiotics followed by 48 hours of post-procedure antibiotics according to local guidelines in each centre.

Each centre will use its existing TRUS biopsy technique in order to reflect “real world” clinical practice (given that there are some minor variances in TRUS biopsy technique from centre to centre across the UK).