Transperineal template-guided mapping biopsy of the prostate

This chapter presents the role of transperineal template-guided mapping biopsy (TTMB) in determining management strategyin patients with low-risk prostate cancer (PCa). TTMB is an effective procedure for detecting PCa in patients who have had previous negative biopsies and a high suspicion of cancer. TTMB shows prostate cancer in one-third of such patients. TTMB is also used to help select patients for prostate cancermanagement. The Transatlantic Consensus Group on Active Surveillance and Focal Therapyfor Prostate Cancer recommends emerging detecting tools such as new imaging techniques and transperineal mapping biopsies to improve prostate cancer management.TTMB was shown to be optimal for detecting clinically significant PCa when compared with other available biopsy options. The transperineal approach allows longitudinal access to the prostate gland and a more accurate sampling, especially on the peripheral anterior and apical part of the gland. Of all biopsy-related complications, 19 % are associated with TTMB; most of them were mild and transient complications.TTMB is a useful resource in clinical practice for several reasons. Over 30 % of patients had been understaged after the initial extended biopsy. In addition, the information these biopsies providehelps to properly select the best candidates for active surveillance programs, focal therapy, or radical therapy. The fusion of advanced imaging guidance with TTMB will be an interesting advance in prostate cancer diagnosis and can potentially overcome most of the shortcomings of present biopsy techniques.