Transperineal biopsy for diagnosing prostate cancer

1.1 Local anaesthetic transperineal (LATP) prostate biopsy using the freehand needle positioning device PrecisionPoint is recommended as an option for diagnosing prostate cancer.

1.2 Although there is considerably less evidence and therefore greater uncertainty of clinical benefit for them, the following freehand needle positioning devices are expected to have similar cancer detection rates and adverse events to those of PrecisionPoint:

1.3 Centres are encouraged to take part in research and data collection, including the randomised controlled trial of transrectal biopsy compared with LATP biopsy (the TRANSLATE trial; see section 3.8) to help refine clinical practice.

1.4 There is not enough evidence to recommend double freehand LATP prostate biopsy using the CamPROBE device. Further research is recommended to understand its clinical effectiveness.

Why the committee made these recommendations

Standard prostate biopsy uses local anaesthetic transrectal ultrasound (LA‑TRUS). This involves taking samples of prostate tissue by inserting a biopsy needle through the rectal wall via the anus. An alternative is LATP prostate biopsy, which involves inserting the needle through the perineum, the skin area between the anus and the scrotum.

Techniques for LATP biopsy vary. It can be done using a freehand needle positioning device, a grid and stepping device, or using a coaxial needle only (double freehand).

The evidence suggests no significant difference in cancer detection rates between LATP biopsy and LA‑TRUS biopsy, but it suggests lower rates of infection and sepsis after LATP biopsies. More evidence on their differences will come from the ongoing TRANSLATE trial, which may help refine clinical practice.

Most of the clinical evidence for freehand needle positioning devices is on the PrecisionPoint device. There is no comparative evidence for the EZU‑PA3U, UA1232, or Trinity Perine Grid devices, but experts suggest that cancer detection rates and adverse events are expected to be similar for the different freehand devices. This is because they all function in a similar way, in that they attach to the ultrasound probe and keep the needle in line with it. The biopsy technique is the same.

The most likely cost-effectiveness estimates for freehand needle positioning devices are within what NICE considers an acceptable use of NHS resources. So, LATP biopsy using a freehand needle positioning device is recommended.

There is no comparative evidence on the CamPROBE device, which uses a double freehand technique. Experts said that because the double freehand technique is different to using the freehand needle positioning devices, more research is needed to understand the cancer detection rates, adverse events and cost effectiveness.