Current evidence on the efficacy of transperineal template biopsy of the prostate shows an increase in diagnostic yield in patients with suspected prostate cancer who have had negative or equivocal results from other biopsy methods. There are no major safety concerns. Therefore, this procedure may be used for this indication provided that normal arrangements are in place for clinical governance, consent and audit.
Evidence was not found to support the use of transperineal template biopsy of the prostate as a mapping technique to determine the exact location and extent of prostate cancer in order to guide focal therapy, nor as part of an active surveillance regime. Therefore, the procedure should be used with these intentions only with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake transperineal template biopsy of the prostate as part of an active surveillance regime or as a mapping technique to guide focal therapy of prostate cancer should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the use of the procedure for active surveillance and/or mapping, and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having transperineal template biopsy of the prostate (see section 3.1).
NICE encourages further research on the use of transperineal template biopsy of the prostate for both mapping and active surveillance. Comparing the results with specimens obtained at prostatectomy will help to define the accuracy of the procedure in determining the location and extent of prostate cancer.