Current Perceptions, Practice Patterns, and Barriers to Adoption of Transperineal Prostate Biopsy under local anesthesia

Asha Bulusu; Stephanie Ferrante; Richard C Wu; Ji Qi; Jim Montie; Kevin B Ginsburg; Alice Semerjian; Jay D Raman; Serge Ginzburg; Amit Patel; Craig G Rogers; Valal K George; Brian Stork; Arvin K George; Michigan Urological Surgery Improvement Collaborative

doi:10.1016/j.urology.2024.04.019

Current Perceptions, Practice Patterns, and Barriers to Adoption of Transperineal Prostate Biopsy under local anesthesia

Urology. 2024 Apr 26:S0090-4295(24)00292-9. doi: 10.1016/j.urology.2024.04.019. Online ahead of print.

Affiliations

¹ Department of Urology, University of Michigan, Ann Arbor, Michigan 48109.
² Department of Urology, E-Da Hospital, Kaoshiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
³ Department of Urology, Wayne State University, Detroit, Michigan 48201.
⁴ Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; IHA Urology, Ypsilanti, Michigan 48197.
⁵ Department of Urology, Penn State Health, Hershey, Pennsylvania 17033.
⁶ Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania 19141.
⁷ Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202.
⁸ Michigan Institute of Urology, Troy, Michigan 48084.
⁹ Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland 21205. Electronic address: arvinkgeorge@gmail.com.

PMID: 38679295
DOI: 10.1016/j.urology.2024.04.019

Abstract

Objectives: To assess perceptions, practice patterns, and barriers to adoption of Transperineal prostate biopsy (TPBx) under local anesthesia.

Methods: Providers from Michigan Urological Surgery Improvement Collaborative (MUSIC) and Pennsylvania Urologic Regional Collaborative (PURC) were administered an online survey to assess beliefs and educational needs regarding TPBx. Providers were divided into those who performed or did not perform TPBx. The MUSIC and PURC registry were queried to assess TPBx utilization. Descriptive analytics and bivariate analysis determined associations between provider/practice demographics and attitudes.

Results: Since 2019, TPBx adoption has increased more than 2-fold to 7.0% and 16% across MUSIC and PURC practices, respectively. Of 350 urologists invited to participate in a survey, a total of 91 complete responses were obtained with 21 respondents (23%) reported performing TPBx. Participants estimated the learning curve was <10 procedure for TPBx performers and non-performers. No significant association was observed between learning curve and provider age/practice setting. The major perceived benefits of TPBx were decreased risk of sepsis, improved cancer detection rate and antibiotic stewardship. The most commonly cited challenges to implementation included access to equipment and patient experience. Urologists performing TPBx reported learning curve as an additional barrier, while those not performing TPBx reported duration of procedure.

Conclusions: Access to equipment and patient experience concerns remain substantial barriers to adoption of TPBx. Dissemination of techniques utilizing existing equipment and optimization of local anesthetic protocols for TPBx may help facilitate the continued adoption of TPBx.