Transcutaneous perineal-ultrasound guided prostate biopsy in men with rectal amputation

To evaluate the use of transcutaneous perineal ultrasound to guide prostate biopsy in men previously submitted to rectal amputation.

From January 2018 to January 2025, 10 men aged between 47 and 76 years (median age: 56 years) previously submitted to proctocolectomy (7 men for rectum cancer and 3 men for benign disease) were evaluated for the suspicion of prostate cancer (PCa). The indications for biopsy were PSA >10 ng/mL or PSA values between 4.1-10 ng/mL with free/total PSA <25% and/or PSA density >0.20. All the patients submitted for the first time to biopsy underwent extended scheme (ePBx: 12-18 cores); in addition, all the patients underwent multiparametric magnetic resonance (mpMRI) and in the presence of a Prostate Imaging-Reporting and Data System-version 2 (PI-RADS) score ≥3 a cognitive targeted biopsy (TPBx:  4 cores) was added to the systematic prostate biopsy. Biopsies were freehand using 18-gauge automatic biopsy needles under perineal real-time ultrasound guidance (3.5 MHz convex probe).

Median PSA was 9.7 (range: 4.8-27 ng/mL); in 1/10 (10%) patient mpMRI was negative, conversely in 3 (30%) vs 3 (30%) vs 3 (30%) men, PIRADS score was 3 vs 4 vs 5, respectively. Overall, a csPCa (ISUPGrade Group > 2/Gleason score > 3+4) was found in 5/10 (50%) patients; PCa was located in the peripheric zone in 4 (80%) cases and 1 (20%) case in the anterior zone of the gland. In detail, ePBx vs. TPBx biopsies diagnosed 5/5 (100%) and 4/5 (90%) csPCa. One patient diagnosed with csPCa had negative mpMRI, 1 and 3 men had PIRADS score 4 and 5, respectively. None had clinical complications that needed hospital admission.

Transcutaneous perineal ultrasound-guided prostate biopsy allows for the performance of accurate systematic and targeted biopsies in men with suspicious PCa previously submitted to rectal amputation.