Dr. Crawford on Transperineal 3D Mapping Biopsy

E. David Crawford, MD, Professor of Surgery and Radiation Oncology, Head, Section of Urologic Oncology, University of Colorado Health Sciences Center, discusses the 3D mapping biopsy, which reconstructs the prostate using a series of transperineal cores along a brachytherapy grid.

The transperineal biopsy is conducted in the area between the scrotum and rectum and is superior to the transrectal approach because of fewer side effects and less infection. The entire prostate can usually be sampled, unless it is large enough that the pubic arches interfere.

For 3D mapping it is best to conduct 2 biopsies per gram of prostate, retrieving 2 17mm cores each. The results are placed into a computer program that builds a 3D reconstruction of the entire prostate. This reconstruction provides a complete picture of the prostate and reveals if the cancer can be treated with a lumpectomy or targeted focal therapy.

In some cases the 3D biopsy reveals cancer on both sides of the prostate or higher-grade tumors, which may require radical prostatectomy or radiation. In general, Crawford adds that transperineal 3D mapping biopsy is well tolerated and provides superior information.