Name of the Procedure:

Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance

Summary

This procedure involves taking multiple tissue samples from the prostate using a thin needle inserted through the perineal skin (the area between the anus and scrotum). The needle's placement is guided by a stereotactic template and imaging techniques to ensure accurate sampling.

Purpose

This procedure is primarily used to diagnose prostate cancer or other prostate conditions. It allows for a thorough examination of the prostate tissue to detect the presence of cancer cells and to determine the extent and aggressiveness of cancer if present.

Indications

• Elevated prostate-specific antigen (PSA) levels
• Abnormal digital rectal exam (DRE) findings
• Previous inconclusive prostate biopsies
• Significant family history of prostate cancer
• Monitoring known prostate cancer

Preparation

• Patients may need to stop taking certain medications, such as blood thinners, a few days before the procedure.
• An enema might be recommended to clear the rectum.
• Antibiotics may be prescribed to prevent infection.
• Fasting might be required if sedation or anesthesia is planned.

Procedure Description

1. The patient is positioned, typically lying on their back with legs raised.
2. Local anesthesia or light sedation is administered to minimize discomfort.
3. An imaging modality, usually ultrasound or MRI, is used to visualize the prostate.
4. A stereotactic template, a grid-like device, is positioned over the perineal area.
5. A thin needle is inserted through the template and guided by the imaging to target specific areas of the prostate.
6. Multiple samples (saturation sampling) are taken from different parts of the prostate.
7. The samples are sent to a lab for analysis.

Duration

The procedure typically takes about 60-90 minutes.

Setting

This procedure is usually performed in a hospital, outpatient surgical center, or specialized urology clinic.

Personnel

• Urologist or radiologist
• Nurses and possibly a technician to assist with imaging
• Anesthesiologist or sedation nurse, if sedation is used

Risks and Complications

• Infection at the biopsy site
• Bleeding or bruising
• Pain or discomfort
• Difficulty urinating
• Blood in urine, semen, or stool
• Rarely, sepsis or severe bleeding requiring medical intervention

Benefits

• Provides a definitive diagnosis of prostate conditions, including cancer.
• Helps in formulating an appropriate treatment plan.
• May detect cancer that other methods miss due to more extensive sampling.

Recovery

• Patients can usually go home the same day.
• Mild discomfort or soreness in the biopsy area for a few days.
• Avoid strenuous activities for 24-48 hours.
• Follow prescribed antibiotics regimen to prevent infection.
• Follow-up appointment with the doctor to discuss biopsy results.

Alternatives

• Transrectal ultrasound-guided biopsy (TRUS)
• MRI-guided biopsy
• Focal therapy monitoring
• Active surveillance in certain cases
• Pros: Less invasive alternatives may have fewer complications.
• Cons: They may be less comprehensive in tissue sampling compared to saturation techniques.

Patient Experience

• Mild discomfort during the procedure, usually well-managed with local anesthesia or sedation.
• Slight pressure or a brief sharp sensation as the needle accesses the prostate.
• Post-procedure soreness or mild bleeding, typically resolving within a few days.
• Instructions for pain relief and care should be closely followed to ensure a smooth recovery.