PostAPR prostate cancer screening and modalities for prostate biopsy

The clinical scenario of a patient with an elevated PSA and no access to the rectum precludes the urologist from performing a DRE or a TRUS biopsy of the prostate. Other approaches to the prostate to allow a biopsy include CT and MRI guided techniques, transurethral ultrasound guided perineal biopsy and TPUS-guided biopsy.

4.1. CT and MRI-guided prostate biopsy

Transgluteal CT-guided prostate biopsy involves imaging the lower pelvis at 10-mm intervals and with a 10-mm slice thickness. The transgluteal approach allows sampling of both sides of the midline at the base, midgland and apical levels. When one entry site is used, the angle of the needle is projected to the contralateral side of the prostate; entry sites are chosen 3-4cm off the midline to avoid paraspinal ligaments and potential post-APR fibrosis around the tip of the coccyx (Figure 1) [19].

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