Freehand Transperineal Prostate Biopsy with Three-Dimensional Ultrasound Organ-Based Tracking

Transperineal prostate biopsy carries a significantly lower risk of infectious complications compared with the transrectal approach. We provide a step-by-step description of our current procedural technique for performing transperineal prostate biopsy under local anesthesia. A key component of our technique is the use of a disposable, probe-mounted needle guide that minimizes the number punctures to the perineal skin and allows for continuous needle visualization throughout the procedure. We have paired this device with a novel fusion biopsy platform that utilizes three-dimensional transrectal ultrasound to enable targeting of suspicious lesions found prebiopsy MRI as well as allows for mapping of biopsy core locations for postprocedure review and use at the time of subsequent prostate biopsy or ablation procedures.