Vol. 191, No. 4S, Supplement, Monday, May 19, 2014 THE JOURNAL OF UROLOGY� e595

MP53-16PROSPECTIVE EVALUATION OF THE SAFETY OF TRANSRECTALULTRASOUND GUIDED TRANSPERINEAL PROSTATE BIOPSYBASED ON ADVERSE EVENTS

Takeshi Namekawa*, Yosuke Sato, Kimiaki Takagi, Takayuki Ozeki,Chiba, Japan; Yusuke Imamura, Vancouver, Canada;Masayuki Kobayashi, Atsushi Komaru, Satoshi Fukasawa, Chiba,Japan; Koichiro Akakura, Tokyo, Japan; Tomohiko Ichikawa,Takeshi Ueda, Chiba, Japan

INTRODUCTION AND OBJECTIVES: This study aimed toprospectively assess the adverse events associated with transrectalultrasound guided transperineal prostate biopsy under lumbar spinalanesthesia at a single facility.

METHODS: This study included 2,086 males who underwenttransrectal ultrasound guided transperineal prostate biopsy under lum-bar spinal anesthesia at Chiba Cancer Center from January 2009 toAugust 2013. Eight adverse events were prospectively assessed usinga purpose-designed questionnaire, and biopsy specimens were ob-tained from 16 predetermined regions of the prostate. All patientsreceived a single intravenous dose of prophylactic antibiotics shortlyafter the biopsy, followed by an oral dose for 3 subsequent days. Oralanticoagulants were discontinued prior to the procedure. The preva-lence and duration of all adverse events were evaluated. Subgroupanalysis for hematuria and urinary retention in relation to clinical factorsand anticoagulant/a-blocker use history was performed. Logisticregression analysis was used for statistical analysis.

RESULTS: Questionnaires for 1,663 cases (79.7%) werecollected. The prevalence and duration of various adverse events areshown in the table.

Nineteen patients (1.1%) required treatment with indwelling urethralcatheterization for grade 2 urinary retention.

Subgroup analysis showed that the prebiopsy International ProstateSymptom Score (IPSS) (p ¼ 0.014) was an independent related factorfor hematuria. Prebiopsy IPSS (p < 0.001), prostate volume (p ¼0.016), and a-blocker use history (p ¼ 0.020) were independent relatedfactors for urinary retention.

CONCLUSIONS: The most frequent adverse events associatedwith transperineal prostate biopsy were minor perineal bleeding andpain. The medical history of oral anticoagulants had no influence onadverse events in respect of their appropriate discontinuation. Thus,transrectal ultrasound guided transperineal prostate biopsy under lum-bar spinal anesthesia can be safely performed with only minoradverse events.

Source of Funding: none

MP53-17TRANSPERINEAL TEMPLATE PROSTATE BIOPSIES: THE NEWGOLD STANDARD FOR PROSTATE CANCER DIAGNOSIS

Shady Nafie*, John Dormer, John Kilian Mellon, Masood Ahmed Khan,Leicester, United Kingdom

INTRODUCTION AND OBJECTIVES: Transrectal Ultrasound(TRUS) guided prostate biopsy is regarded as the gold standard forprostate cancer diagnosis. Transperineal template prostate biopsy

(TPTPB) has been shown to improve prostate cancer detection in menwith a rising PSA and previous negative TRUS guided prostate bi-opsies. We performed a prospective study directly comparing theprostate cancer detection rate between TRUS guided biopsy andTPTPB in 50 men with a benign feeling DRE, PSA < 20 ng/mL and noprevious prostate biopsies.

METHODS: 50 patients with a mean age of 67 years (range:54-84), mean prostate volume of 58 cc (range:19-165) and mean PSAof 8 ng/L (range: 4-18) underwent standard 12-core TRUS guidedprostate biopsy followed immediately by 36-core TPTPB under generalanesthetic. We determined the prostate cancer detection rate betweenthe two diagnostic modalities.

RESULTS: A total of 20/50 (40%) men had benign pathology.Of the 30/50 (60%) diagnosed with prostate cancer 16 (32%) hadpositive results in both TRUS and TPTPB, while 14 (28%) had negativeTRUS but positive TPTPB. Hence, TRUS guided prostate biopsydetected cancer in 32% whereas it was 60% with TPTPB. Furthermore,no cancers were detected solely by TRUS biopsy. In 19/30 (63%) thecancers detected by TPTPB had Gleason score � 7. In total, 2 (4%)patients experienced urosepsis, 7 (14%) temporary urinary retention, 16(32%) had mild haematuria and 19 (38%) haematospermia.

CONCLUSIONS: TPTPB is associated with a significantlyhigher prostate cancer detection rate compared to TRUS biopsies (60%vs. 32%, p<0.0001) in men with an elevated PSA < 20 ng/mL and abenign feeling prostate. We propose that TPTPB should be regarded asthe biopsy technique of choice in this group of men. In addition, PSAappears to be a better biomarker for prostate cancer than previ-ously thought.

Source of Funding: None.

MP53-18COMBINED PERIANAL-INTRARECTAL TETRACAINE CREAM ANDTOTALLY PERIPROSTATIC NERVE BLOCK IMPROVES PAINCONTROL DURING TRANSRECTAL ULTRASOUND GUIDEDBIOPSY OF THE PROSTATE

Pengchao Li*, Hongqing Cui, Zengjun Wang, Changjun Yin, Lixin Hua,Ninghong Song, Nanjing, China, People’s Republic of

INTRODUCTION AND OBJECTIVES: Periprostatic nerve block(PPNB) is recommended as the standard method to alleviated painduring transrectal prostate biopsy (TRPB). However, the process ofPPNB may be painful and the effect of PPNB may be insufficient forcertain patients. We compared pain control results between totallyPPNB alone and PPNB combined with topical perianal-intrarectaltetracaine cream during TRPB.

METHODS: One hundred and eighty cases of TRUS-guidedprostate biopsy in our department from July 2012 to June 2013 weredivided into three groups: 80 patients (Group A) without local anes-thesia, 50 patients (Group B) underwent totally PPNB, 50 patients(Group C) underwent combined perianal-intrarectal tetracaine creamand totally PPNB. Perianal-intrarectal tetracaine cream was adminis-tered 30 minutes before biopsy. Totally PPNB was performed byinjecting lidocaine around seminal vesicle, in the junction betweenprostate and bladder neck, and along the bilateral neurovascularbundle. A 22 G puncture needle was placed through a transrectal ul-trasound biopsy guide. Thirteen-core biopsies were performed.Following biopsy, we accessed the pain by Visual Analog Scale (VAS)assessment. The VAS score included different period when insertingultrasound probe (VAS1), injecting lidocaine (VAS2), harvesting speci-mens (VAS3) and 30 minutes after biopsy (VAS4).

RESULTS: The incidences of infection was comparable be-tween 3 groups. The VAS1 of group C was lower than group B (P <

0.01), group A (P < 0.01). No significant difference was found betweenthe VAS1 of group A and group B (P ¼ 0.825). The VAS2 of group Cwas lower than group B (P < 0.01) when performing totally PPNB. TheVAS3 of group C was lower than group B (P < 0.01), and VAS3 ofgroup B was lower than group A (P < 0.01). The VAS4 of group C waslower than group B (P < 0.01), and VAS4 of group B was lower thangroup A (P < 0.01).