Focus of the Report: This report focuses on transperineal template prostate (TTP) biopsy as an alternative to standard transrectal ultrasound (TRUS) biopsy for purposes of confirming candidacy for active surveillance or for restaging during active surveillance in men who previously had biopsy results that were positive for favorable-risk prostate cancer.

Technology Description: TTP biopsy is a form of prostate saturation biopsy (at least 20 cores) that uses a brachytherapy grid to assure even distribution of the sample cores. TTP biopsy differs from TRUS biopsy in 2 key ways: route of needle insertion and method of determining biopsy sites. The needle is inserted transrectally in TRUS biopsy procedures, and is inserted through the perineum (the area between the anus and scrotum) in TTP biopsy procedures. In TRUS biopsy procedures, biopsy sites (typically 10 to 12) are selected randomly. TTP biopsy involves the use of a sterile, disposable template (i.e., brachytherapy grid) through which the biopsy needles are inserted in a manner that assures uniform spacing. Both TTP biopsy and TRUS biopsy use a rectal ultrasound probe for visualization. TTP biopsy is typically performed as a same-day procedure with the patient under general anesthesia.

Controversy: The disadvantages of TTP biopsy are the need for general anesthesia that results in both greater costs and longer procedure time, a requirement for greater expertise on the part of the clinician performing the biopsy, and an elevated risk of complications attributable to the greater number of cores obtained.

Key Questions:

  • Is TTP biopsy accurate in confirming the grade and stage of prostate cancer or monitoring disease progression (clinical validity) in men who are under or are considering active surveillance following detection of clinically insignificant prostate cancer?

  • Does the use of TTP biopsy change treatment decisions or improve health outcomes (clinical utility)?

  • How does TTP biopsy compare with other types of prostate biopsy (e.g., TRUS biopsy)?

  • Is TTP biopsy safe?

  • Have definitive patient selection criteria been identified?

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