Device-Free, Free-Handed Transperineal Prostate Biopsy Technique

Overview

Fox Chase Cancer Center presents a minimally invasive, device-free transperineal prostate biopsy method that reduces infection risk and procedural costs. This free-handed approach requires only two needle punctures, can be performed in-office under local anesthesia, and improves access to anterior prostate regions.

Background

Prostate biopsy traditionally uses a transrectal approach involving multiple needle punctures through the rectum, which carries risks such as sepsis and rectal bleeding. The transperineal approach offers a safer alternative with fewer punctures and lower infection rates. Most transperineal biopsies use a device coupling the ultrasound probe to the needle, but Fox Chase Cancer Center has developed a free-handed technique that eliminates this device, allowing greater maneuverability and cost savings. This method also facilitates cognitive targeting and can be performed without general anesthesia.

Data Highlights

The free-handed transperineal biopsy uses two needle punctures—one on each side of the prostate—compared to 12 or more punctures in traditional transrectal biopsies. Local anesthesia involves 5 cc of 0.25% lidocaine injected at each puncture site. The biopsy template models a 12-core scheme sampling medial and lateral peripheral zones and wings of the prostate, with additional cores taken if indicated by MRI findings.

Key Findings

• The free-handed transperineal biopsy technique avoids the need for an ultrasound needle mount, saving several hundred dollars per procedure.
• Only two needle punctures are required, reducing patient discomfort and procedural complexity.
• The approach significantly lowers the risk of post-biopsy sepsis and rectal bleeding compared to transrectal biopsies.
• It allows anterior-posterior pivoting of the ultrasound probe, improving access to anterior prostate regions.
• The procedure can be safely performed in-office under local anesthesia without general sedation.
• Proper core handoff technique preserves specimen architecture, enhancing pathological interpretation.

Clinical Implications

This device-free, free-handed transperineal biopsy technique offers a cost-effective, safer alternative to traditional transrectal biopsies, with fewer punctures and reduced infection risk. Its ability to be performed under local anesthesia in an office setting may improve patient comfort and accessibility. Clinicians should consider adopting this method to enhance biopsy accuracy and reduce complications.

Conclusion

The free-handed transperineal prostate biopsy is a safe, effective, and economical technique that improves patient outcomes by minimizing infection risk and procedural invasiveness. Its adoption may represent a significant advancement in prostate cancer diagnostic procedures.

References

1. Fox Chase Cancer Center Urologic Oncology -- How to Perform Device-Free, Free-Handed Transperineal Prostate Biopsy