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

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

Materials and methods: 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).

Results: 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.

Conclusions: 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.