title: Transperineal sector prostate biopsies: a local anesthetic outpatient technique.
abstract: OBJECTIVE
  To describe our technique and determine the feasibility and tolerability of transperineal template prostate (TP) biopsies under local anesthesia (LA).
  
  
  METHODS
  Fifty consecutive patients underwent TP biopsies under LA for investigation of an elevated prostate-specific antigen level or risk stratification as part of our active surveillance protocol. Tolerability was evaluated with a visual analog scale assessing probe discomfort, LA infiltration, and the biopsy procurement. Patients were also asked if they would have the procedure again, and in those who had undergone previous transrectal biopsies, how the TP technique compared. Pathologic data, clinical outcomes, and complications were recorded at 2 weeks.
  
  
  RESULTS
  Mean age was 62.8 years (standard deviation [SD], 6.34 years) and the mean prostate-specific antigen level was 8.49 ng/mL (SD, 6.36 ng/mL). Mean prostate volume was 48.2 mL (SD, 19.4 mL). Mean visual analog scale scores for discomfort caused by the ultrasound probe, LA injections, and biopsies were 3.08 (SD, 1.64), 3.29 (SD, 1.13), and 2.88 (SD, 1.28), respectively. Thirty-four of 50 men (68%) had positive histology, 26 men had Gleason score≤3+4, 5 men had Gleason score≥4+3, and 3 had recurrent adenocarcinoma after radiotherapy. There were 2 complications: 1 Clavien score 1 and 1 Clavien score 3a.
  
  
  CONCLUSIONS
  LA TP biopsies are well tolerated, acceptable, and feasible when carried out within an outpatient setting.
authors.affiliation: Department of Urology, Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Urology, University Hospital Southampton, Southampton, Hampshire, United Kingdom. Electronic address: jsmithurol@gmail.com.
authors.forename: Julian B
authors.initials: JB
authors.lastname: Smith
authors.affiliation: Department of Urology, Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Rick
authors.initials: R
authors.lastname: Popert
authors.affiliation: Department of Urology, Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Urology, Mid Essex Hospitals NHS Trust, Chelmsford, Essex, United Kingdom.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Nuttall
authors.affiliation: Department of Urology, Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Lona
authors.initials: L
authors.lastname: Vyas
authors.affiliation: Department of Urology, Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Janette
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Department of Urology, Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Declan
authors.initials: D
authors.lastname: Cahill
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010502:Perineum; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*; D018570:Risk Assessment; D047368:Tumor Burden
chemical_list: D000779:Anesthetics, Local; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen