Stereotactic Transperineal Prostate Biopsy-STPB
History of Stereotactic Transperineal Prostate Biopsy
Going Beyond the Standard Transrectal Biopsy
According to the American Cancer Society, 1 in 9 men will be diagnosed with prostate cancer in their lifetime. The majority of these diagnoses are made with a standard transrectal biopsy administered in the office by urologists. Doctor’s and pathologists are generally looking for PSA levels higher than normal with these tests - but the problem with the standard transrectal biopsy is often times a patient will have a continued rising PSA, despite having had a negative office biopsy. This causes anxiety for patients and physicians - because the results are unclear.
What is Stereotactic Transperineal Prostate Biopsy (STPB)?
Fortunately, Chicago Prostate Cancer Center has developed Stereotactic Transperineal Prostate Biopsy or STPB. This is the most comprehensive, sophisticated prostate biopsy technique available, diagnosing 40% more cancer than the standard office procedure—cancer that would have otherwise gone undetected.
Many of the cancers missed by the standard transrectal biopsy are in the apex of the prostate gland. The apex of the prostate gland is located at the bottom of the gland. The apex is pointed down to the perineum as opposed to the base which is wider and located next to the bladder.
What are the Advantages of Stereotactic Transperineal Prostate Biopsy (STPB)?
Stereotactic Transperineal Prostate Biopsy has many advantages, the first of which is its increased ability to identify occult or “hiding cancers”. Our research and the research of others have clearly demonstrated that the transrectal biopsy does miss a significant percentage of cancers that occur in the anterior or front portion of the prostate. Our data in over 2,200 patients suggests that as high as 40% of patients are thought not to have malignancy, but indeed do have malignancy. Our group has previously published this information in Urology and the Journal of Urology.
The second advantage to having a prostate biopsy using the perineal approach is that the infection rate is essentially 0%. This is simply because the rectal wall or rectum in general is not penetrated by the biopsy needle. As we know, infection is not uncommon after transrectal prostate biopsy and unfortunately the bacteria that are currently being identified have significant resistance to commonly used antibiotics. Our initial experience using Stereotactic Transperineal Prostate Biopsy was confined primarily to patients who were diagnostic dilemmas in that they had persistent elevation of PSA level, while the biopsies were negative. More and more commonly today, patients are requesting perineal biopsy as their initial biopsy technique. This is because they have learned of the mapping ability using this procedure.
Diagnosing 40% more cancer
One-time, out-patient procedure (no hospital stay needed)
Minimally invasive (no incisions or stitches)
Performed under general anesthesia with no discomfort
Infection rate negligible
Confidence in exact location of cancer
Minimal, if any, post-operative pain
- Return to normal activity within a day
How does the Stereotactic Transperineal Prostate Biopsy Procedure Work?
Stereotactic Transperineal Prostate Biopsy is performed by comprehensively sampling the prostate through the perineum while the patient is under general anesthesia. Performed as an outpatient procedure, it allows more comprehensive sampling, compared to the transrectal method, which takes fewer samples through the rectum. Unlike random sampling with transrectal prostate biopsy, with our extensive template-guided approach, we are able to identify exactly where the positive and negative specimens were retrieved. This allows for more sophisticated treatment plans for those with positive biopsies, and relief for those patients whose biopsies were negative.
In the standard transrectal prostate biopsy, specimens are obtained through the rectum where large amounts of bacteria are present. The transrectal method to obtain tissue samples, can result in urologic complications including bacteria in the urine, urinary tract infection (UTI), bacteria in the blood, fever episodes, and sepsis (pathogenic microorganisms or their toxins in the blood) in a patient (1-2). These serious infections after transrectal biopsy are often resistant to antibiotics and require hospitalization, leading to death in 1/1000 men (2). During STPB, the prostate specimens are obtained through the perineum and therefore, we have not seen any infection.
Our patients often tell us how grateful they are for giving them peace of mind with regards to whether or not they have prostate cancer. Finally, Stereotactic Transperineal Prostate Biopsy is covered by most insurance plans, including Medicare.
Contact Chicago Prostate Cancer Center with Questions About Stereotactic Transperineal Prostate Biopsy
If you have had a rising PSA or abnormal digital rectal exam, call us today to find out more.
- Zaytoun OM, Vargo EH, Rajan R et al. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: Implications for prophylaxis and treatment. Urology, May 2011, Vol 77(5), 1035-1041.
- Nam RK, Saskin R, Lee Y et al. Increasing hospital admission rates for urologic complications after transrectal ultrasound guided prostate biopsy. Journal of Urology, March 2010, Vol 183, 963-969.
“I felt from the very beginning that I was receiving the latest technology from the most qualified and caring people. Friends and Family couldn’t believe how relaxed I have been leading into the date of the procedure. That is because I was totally confident that I was experiencing the best care. I also heard nothing but positive comments from 5 people who had experienced a successful procedure and result at CPCC.”
— John H.– Naperville, Illinois