Stereotactic Transperineal Prostate Biopsy (STPB)

Dr. Moran has devel­oped Stereo­tac­tic Transper­ineal Prostate Biop­sy (STPB). This is the most com­pre­hen­sive, sophis­ti­cat­ed prostate biop­sy tech­nique avail­able, diag­nos­ing 40% more can­cer than the stan­dard office pro­ce­dure — can­cer that would have oth­er­wise gone undetected.

Many of the can­cers missed by the stan­dard tran­srec­tal biop­sy are in the apex of the prostate gland. The apex of the prostate gland is locat­ed at the bot­tom of the gland. The apex is point­ed down to the per­ineum as opposed to the base which is wider and locat­ed next to the bladder. 

Stereo­tac­tic Transper­ineal Prostate Biop­sy has many advan­tages, the first of which is its increased abil­i­ty to iden­ti­fy occult or ​“hid­ing can­cers”. Our research and the research of oth­ers have clear­ly demon­strat­ed that the tran­srec­tal biop­sy does miss a sig­nif­i­cant per­cent­age of can­cers that occur in the ante­ri­or or front por­tion of the prostate. Our data in over 2,200 patients sug­gests that as high as 40% of patients are thought not to have malig­nan­cy, but indeed do have malig­nan­cy. Dr. Moran has pre­vi­ous­ly pub­lished this infor­ma­tion in Urol­o­gy and the Jour­nal of Urology.

The sec­ond advan­tage to hav­ing a prostate biop­sy using the per­ineal approach is that the infec­tion rate is almost 0%. This is sim­ply because the rec­tal wall or rec­tum in gen­er­al is not pen­e­trat­ed by the biop­sy nee­dle. Infec­tion is com­mon after tran­srec­tal prostate biop­sy, but STPB sig­nif­i­cant­ly decreas­es your risk for infection. 

STPB is per­formed by com­pre­hen­sive­ly sam­pling the prostate through the per­ineum while the patient is under gen­er­al anes­the­sia. Per­formed as an out­pa­tient pro­ce­dure, it allows more com­pre­hen­sive sam­pling, com­pared to the tran­srec­tal method, which takes few­er sam­ples through the rec­tum. Unlike ran­dom sam­pling with tran­srec­tal prostate biop­sy, with our exten­sive tem­plate-guid­ed approach, we can iden­ti­fy exact­ly where the pos­i­tive and neg­a­tive spec­i­mens were retrieved. This allows for more sophis­ti­cat­ed treat­ment plans for those with pos­i­tive biop­sies, and relief for those patients whose biop­sies were negative.

Over­all ben­e­fits of STPB include:

• Diag­nos­ing 40% more cancer
• One-time, out-patient pro­ce­dure (no hos­pi­tal stay needed)
• Min­i­mal­ly inva­sive (no inci­sions or stitches)
• Per­formed under gen­er­al anes­the­sia with no discomfort
• Infec­tion rate negligible
• Con­fi­dence in exact loca­tion of cancer
• Min­i­mal, if any, post-oper­a­tive pain
• Return to nor­mal activ­i­ty with­in a day