Indications, complications and effectiveness of transperineal template biopsy of the prostate

The use of transperineal template biopsy (TPTB) is increasing in the diagnostic pathway of prostate cancer. Compliance to NICE interventional procedure guidance 364 (2010) should be audited in any centre performing template biopsies.

TPTB offers accurate histological diagnosis and mapping of prostate cancer, which is of importance in guiding management options: active surveillance (AS), focal and salvage therapy. NICE recommends TPTB for patients with suspected prostate cancer with negative or inconclusive transrectal biopsies [1]. The indications, complication rates and effectiveness should be audited.

The standard: 

• 100% compliance with NICE recommendations for definite indications for performing template biopsies on patients with suspected prostate cancer with negative or inconclusive transrectal biopsies. Proposed indications include mapping technique to determine exact location and extent of prostate cancer to guide focal treatment and as an active surveillance regime

• NICE quotes prostate cancer detection in 38-76% of procedures

• Complication rates quoted by NICE are: haematospermia <1-1.6%, infection <1%, fever 0%, urinary retention 1.6-11.4% and haematuria 1.6-35.3%

Target: 

• 100% compliance with indications

• Prostate cancer detection rates equivalent or higher than NICE recommendations

• Complication rates below those quoted by NICE

Indicators: 

Proportion of patients who undergo template biopsy.

Data items to be collected: 

1. Indications for biopsy from referral letter

2. Complications post procedure

3. Patients Gleason score, clinical stage pre and post biopsy

Suggested number: 

More than 50 (can be lesser depending on hospital's caseload).

Presentation of audit findings at local clinical team meeting:

• To identify reasons for patients offered template biopsies not within indication stated and its appropriateness

• To identify reasons for higher complication rates

• To identify reasons for decreased effectiveness

Collaboration with radiologist and urologist for this audit is recommended.

1. NICE 2010. Transperineal template biopsy and mapping of the prostate: Interventional procedure guidance 364. https://www.nice.org.uk/guidance/ipg364

Pei LIM