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Biopsies. LATP or TRUS. Which is best?

User
Posted 19 Jun 2025 at 08:57

Recent research concluded:

[In summary, LATP results in greater detection of GGG 2 or higher prostate cancer versus TRUS biopsy, but with higher immediate post-procedure pain and embarrassment, and takes longer to perform. TRUS biopsy results in higher procedure-related symptoms than LATP beyond 7 days. TRANSLATE provides the evidence necessary when considering trade-offs and deciding which biopsy to adopt.]

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00100-7/fulltext

Late in 2020, I had a TRUS biopsy. There were 14 cores taken, only 2 were cancerous, one in each core, T2c staging, both Gleason 6 (3+3). The MDT advised active surveillance. I agreed. During this time my PSA fluctuated a little between 5.6 and 6.7.

A much delayed 😡 follow up MRI scan, 22 months later, showed significant disease progression. I was advised to have a further biopsy, this time LAPT under general anaesthetic, because it was, "far more accurate"

This time, 24 cores were taken. 20 cores from different target areas. Gleason scores varied between 7(3+4), 7(4+3) and 8(3+5). Overall 8(3+5).

I had RARP and was upgraded to Gleason 9(4+5), T3a.

I now believe that it is rare for this disease to grow fast and also rare for a lesion's Gleason score to raise. Therefore I can only assume that it was more likely that the TRUS biopsy missed a lot of the cancerous cells rather than the disease progressing at pace.

I'm not medically trained. However, it has become evident to me how important it is to have accurate biopsies, they are crucial to any follow up treatment plans.

Would you say, that my TRUS biopsy, where I was on a bed in a consultant's office, with my knees up to my chest, shaking like a sh*tting dog, whilst something was being rammed up my bum, was likely to be as accurate as being fast sleep in an operating theatre and knowing nothing about what was going on?

 

Edited by moderator 19 Jun 2025 at 09:28  | Reason: Not specified

User
Posted 19 Jun 2025 at 10:41
I asked my consultant about the different biopsy options and he likened Trans Rectal to a medieval practice he hadn't seen for many years! The more interesting comparison is between Trans Perineal under local and general anaesthetic. In my case it was local but I found the discomfort tolerable so I'm not sure whether accuracy would have been better if I were fully unconscious.
User
Posted 19 Jun 2025 at 11:30

During my TRUS biopsy, I was wriggling around more than a worm in a wet sock. Hitting my prostate, must have been like clay pigeon shooting.

As you say, sans prostate, I think it's more a case of which is best LATP under local or general anaesthetic. I was definitely told by a urologist consultant that the procedure under GA was much more accurate, because the patient was more still and that makes logical sense to me. However, I'm guessing, that cost is a big deciding factor and that  LATP with GA is far more costly.

Edited by member 20 Jun 2025 at 08:00  | Reason: Typo

 
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