Transperineal free-hand mpMRI fusion-targeted biopsies under local anesthesia: technique and feasibility from a single-centre prospective study

Abstract Objective To evaluate the feasibility of ‘’in-office’’ TPFBx under LA. Materials and Methods We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of PCa, according to pre-defined exclusion criteria. Results We included 459 men (TPFBx n=279 including n=338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n=180). Median procedural time and maximum pain were 19 minutes and 5 NRS points; pain was highest at the time of LA. Only one major complication occurred (Clavien 3a). Haematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and one case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (p=0.86 and p=0.89). In comparison with TPSBx the sole differences were pain during prostatic sampling (p=0.03), duration of haematospermia (p Conclusions TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csPCa detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.