How to Perform Device-Free, Free-Handed Transperineal Prostate Biopsy

Fox Chase Cancer Center’s urologic oncology group shares an educational video that provides instruction on how to perform a device-free, free-handed transperineal prostate biopsy.

Urologic oncologists at Fox Chase Cancer Center have adopted a minimally invasive and device-free approach to prostate biopsy called the free-handed transperineal prostate biopsy.

Traditionally, prostate biopsy was performed transrectally. A transrectal biopsy could involve 12 or more separate needle punctures inside the rectum. The transperineal approach can be done in-office and involves only two needle punctures – one for each side of the prostate. Other benefits include a lower risk of post-biopsy sepsis, reduced risk of rectal bleeding, and a lower barrier to cognitive targeting.

The majority of providers offering the transperineal approach use a mount that couples the ultrasound probe to needle aperture. With this device-free, free-handed approach, clinicians are able to forgo the ultrasound needle mount, which saves hundreds of dollars per procedure and allows for anterior posterior pivoting.

For the patient, the transperineal approach is a safer approach that can be performed anesthesia-free when necessary. Additionally, studies have shown that the transperineal approach may be more effective in detecting cancer than transrectal biopsies.

In this video, an experienced clinician first demonstrates equipment and table setup prior to the procedure and models the transperineal prostate template. The video includes demonstrations of patient positioning, marking of angiocatheter placement, positioning of the ultrasound probe, and administration of superficial and deep anesthetic. Next, the clinicians demonstrate the freehanded biopsy approach.

Importantly, the video includes a demonstration of core handoff. Proper core hand off ensures that the core's architecture remains intact, which greatly enhances the pathological interpretation of the specimens.

This video demonstrates that free-handed transperineal prostate biopsies can be performed safely and effectively in the office with good patient anesthesia, providing substantial benefits compared with transrectal biopsies. 

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Physician Resources | Fox Chase Cancer Center

Related Presenters

Alexander Kutikov, MD, FACS

Alexander Kutikov, MD, FACS

Chair and Professor, Department of Urology;
Roberta R. Scheller Chair in Urologic Oncology;
Fox Chase-Temple Urologic Institute provider