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Biopsy type

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User
Posted 01 Dec 2023 at 19:05

Last week an MRI shows my husband has 2 PI-RADS 4 lesions. His biopsy is scheduled for the 11th of this month. He is having a transrectal biopsy along with a volume study.  I think she either said focus or fusion, but I only had a paint stirrer and a colored pencil to take notes with so  my notes are s***. My question:

Is there a difference in accuracy between the transrectal and transperinial biopsy? I thought the later would have a decreased risk of infection.  Just wondering why one kind is chosen over the other.

 

Thanks

Jay

User
Posted 03 Dec 2023 at 20:18

The ultrasound probe image is of quite limited quality, although it is much more useful in trained hands than it appears to an untrained observer.

A fusion biopsy takes the previously acquired MRI or CT scan images which are usually much better quality, and merges this into the live ultrasound image, so the surgeon doing the biopsy is seeing a live image of the quality of the MRI or CT scan, while only using live ultrasound imaging.

A fusion biopsy can be done with either TRUS or LATP biopsies, since the imaging is the same for both of them.

A fusion biopsy is a form of guided biopsy, but any biopsy where the targets are selected from previous imaging is a guided biopsy, even if it's not a fusion biopsy. A well practiced biopsy nurse or consultant will be able to hit identified lesions from previous MRI scans even if they aren't looking at a live fusion image, although the fusion biopsy makes this easier and more accurate.

User
Posted 04 Dec 2023 at 10:48

I had a transpersonal template biopsy with local anaesthetic about 2 weeks after an MRI. Not a particularly pleasant experience but over with quickly and results back in 10 days. Cystoscopy and bone scan the following week gave a diagnosis of T3b N0 M0 gleason 9.

I had gold seed markers inserted a few weeks later and this via the anal route with an ultrasound probe in your bum. A dose of antibiotics was given to avoid potential infection.

Had no problems with either procedure.. Age (78) and staging pushed me down the RT/HT route. 18 months  later so far so good apart from the rotten effects of HT zoladex which are still with me.

A kind touch was a nurse holding my hand and chatting whilst the surgeon did the biopsy.

Peternigel

User
Posted 01 Dec 2023 at 23:35

A transperineal biopsy takes about twice as many samples so is more accurate.  Many hospitals do it as standard now, whereas transrectal used to be standard.  Yes they say a transperineal is a lower risk of infection.

It used to be standard to do the biopsy first but now they do the MRI first so a transrectal can be aimed at where they see anything suspicious.  You might therefore say a transperineal could be excessive treatment although many people insist that's what you should have for accuracy and lower risk.

I'm not sure I'd insist on a transperineal though.  Especially if it was a non-standard treatment at the hospital.  It could be they'd do a general anaesthetic rather than a local or send you to another hospital.  It depends on how anxious you are to get the result.  The MRI may have given you an indication.

Some people say you may end up having a transperineal because the transrectal didn't find it although the chances of that after an MRI are reduced from what they used to be.

There are a few things to think about and perhaps ask the doctor if you want to. I must admit I'm a get it done sort of person especially as people tend to be waiting longer and the winter rush is round the corner.  Good luck, Peter

 

User
Posted 01 Dec 2023 at 23:57

Hi Jay,

May be helpful reading this this conversation:

https://community.prostatecanceruk.org/posts/t29976-MRI-showed-abnormality---biopsy-imminent

Best of luck.

Adrian

User
Posted 02 Dec 2023 at 06:33

Jay, there are variations of the transperinial biopsy, I will leave the experts to explain.

I had the much maligned trus biopsy almost ten years ago,for me it was a walk in the park, without any issues and it found 10 out of 12 positive samples. Procedures have progressed and we would hope the transperinial are an improvement.

Thanks Chris 

User
Posted 03 Dec 2023 at 13:22
I think it is important to understand the difference between the (now old0fasioned and rather discredited) TRUS biopsy and the more modern targeted or fusion trans-rectal biopsy. TRUS was like sticking a pin into a fruitcake and hoping to spear a cherry - fusion means they have an image of the cherry and superimpose this over a scan of the prostate so that they can stick the pin in the right place.

Despite posts here saying otherwise, my understanding is that, following a short spurt of increasing popularity 4 or 5 years ago, transperineal is now not the most commonly offered biopsy around the country and fusion biopsy has taken over. This is partly down to the early days of the pandemic - operating theatres were being closed down to make more space for Covid patients and it was better for patients not to be in hospital for a general anaesthetic if it could possibly be avoided.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 01 Dec 2023 at 23:35

A transperineal biopsy takes about twice as many samples so is more accurate.  Many hospitals do it as standard now, whereas transrectal used to be standard.  Yes they say a transperineal is a lower risk of infection.

It used to be standard to do the biopsy first but now they do the MRI first so a transrectal can be aimed at where they see anything suspicious.  You might therefore say a transperineal could be excessive treatment although many people insist that's what you should have for accuracy and lower risk.

I'm not sure I'd insist on a transperineal though.  Especially if it was a non-standard treatment at the hospital.  It could be they'd do a general anaesthetic rather than a local or send you to another hospital.  It depends on how anxious you are to get the result.  The MRI may have given you an indication.

Some people say you may end up having a transperineal because the transrectal didn't find it although the chances of that after an MRI are reduced from what they used to be.

There are a few things to think about and perhaps ask the doctor if you want to. I must admit I'm a get it done sort of person especially as people tend to be waiting longer and the winter rush is round the corner.  Good luck, Peter

 

User
Posted 01 Dec 2023 at 23:57

Hi Jay,

May be helpful reading this this conversation:

https://community.prostatecanceruk.org/posts/t29976-MRI-showed-abnormality---biopsy-imminent

Best of luck.

Adrian

User
Posted 02 Dec 2023 at 06:33

Jay, there are variations of the transperinial biopsy, I will leave the experts to explain.

I had the much maligned trus biopsy almost ten years ago,for me it was a walk in the park, without any issues and it found 10 out of 12 positive samples. Procedures have progressed and we would hope the transperinial are an improvement.

Thanks Chris 

User
Posted 03 Dec 2023 at 13:22
I think it is important to understand the difference between the (now old0fasioned and rather discredited) TRUS biopsy and the more modern targeted or fusion trans-rectal biopsy. TRUS was like sticking a pin into a fruitcake and hoping to spear a cherry - fusion means they have an image of the cherry and superimpose this over a scan of the prostate so that they can stick the pin in the right place.

Despite posts here saying otherwise, my understanding is that, following a short spurt of increasing popularity 4 or 5 years ago, transperineal is now not the most commonly offered biopsy around the country and fusion biopsy has taken over. This is partly down to the early days of the pandemic - operating theatres were being closed down to make more space for Covid patients and it was better for patients not to be in hospital for a general anaesthetic if it could possibly be avoided.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 03 Dec 2023 at 14:37
I had no idea that there were multiple types of rectal biopsy. Mine (Nov 22) was done with two huge screens that showed the surgeon where to take the samples and with some sort of probe in the rectum. So maybe it wasn't a TRUS but it was definitely up my bum :)
User
Posted 03 Dec 2023 at 14:46

My biopsy was a template biopsy and it was done under general anaesthetic, I did not at the time bother to investigate what that entailed (still don't know) suffice to say it confirmed I had pca!

User
Posted 03 Dec 2023 at 15:20

Originally Posted by: Online Community Member
So maybe it wasn't a TRUS but it was definitely up my bum :)

Both TRUS and newer LATP use an ultrasound imaging probe up the bum.

User
Posted 03 Dec 2023 at 16:52

I haven't seen the acronym LATP before, as in Andy's post, it's a Local Anaesthetic Transperineal prostate biopsy.   Although I've read a few people on here having a local for a transperineal.

On searching that I found this defence of LATP as the preferred method on Coventry hospital website:

'2. What is the standard management and why does it need
changing?

 The standard management in the NHS is the transrectal ultrasound prostate biopsy (TRUS).

 Since the COVID-19 pandemic started we have stopped using transrectal ultrasound prostate biopsy (TRUS). This is because TRUS carries a risk of sepsis of 1-3% and our bed availability to treat septic patients has been reduced.

 For the last 4 years local anesthetic transperineal prostate biopsy (LATP) has been used successfully by many NHS hospitals.

 Local anaesthetic transperineal prostate biopsy (LATP) has better detection rates than TRUS prostate biopsy. Many NHS hospitals use it for repeat biopsy, replacing transperineal template biopsy.

 We are now using local anaesthetic transperineal prostate biopsy (LATP) to avoid delays in the diagnosis or follow-up of prostate cancer. This helps us to improve our cancer detection rates and decreases procedure related complications.'

.................................

That said I personally would be OK to be offered a guided TRU after an MRI which I think is what Lyn is calling a fusion TRU biopsy.   Although a guided LATP sounds a better option if it's available.

I have the impression that methods are often chosen by hospitals based on decisions peculiar to the staff, equipment or conditions in that hospital.   An example is the psa threshold of detectable, which as a humble layman, I have quite strong opinions about.  Also that my hospital didn't have a robot when I had my op. 

User
Posted 03 Dec 2023 at 20:18

The ultrasound probe image is of quite limited quality, although it is much more useful in trained hands than it appears to an untrained observer.

A fusion biopsy takes the previously acquired MRI or CT scan images which are usually much better quality, and merges this into the live ultrasound image, so the surgeon doing the biopsy is seeing a live image of the quality of the MRI or CT scan, while only using live ultrasound imaging.

A fusion biopsy can be done with either TRUS or LATP biopsies, since the imaging is the same for both of them.

A fusion biopsy is a form of guided biopsy, but any biopsy where the targets are selected from previous imaging is a guided biopsy, even if it's not a fusion biopsy. A well practiced biopsy nurse or consultant will be able to hit identified lesions from previous MRI scans even if they aren't looking at a live fusion image, although the fusion biopsy makes this easier and more accurate.

User
Posted 04 Dec 2023 at 10:48

I had a transpersonal template biopsy with local anaesthetic about 2 weeks after an MRI. Not a particularly pleasant experience but over with quickly and results back in 10 days. Cystoscopy and bone scan the following week gave a diagnosis of T3b N0 M0 gleason 9.

I had gold seed markers inserted a few weeks later and this via the anal route with an ultrasound probe in your bum. A dose of antibiotics was given to avoid potential infection.

Had no problems with either procedure.. Age (78) and staging pushed me down the RT/HT route. 18 months  later so far so good apart from the rotten effects of HT zoladex which are still with me.

A kind touch was a nurse holding my hand and chatting whilst the surgeon did the biopsy.

Peternigel

 
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