Birmingham Prostate Clinic is one of the first to introduce new template biopsies

26th April 2010

Birmingham Prostate Clinic has introduced a new diagnostic test called the template biopsy.

This is a new approach, using precise mapping of the prostate, to help men who have repeated negative biopsies but are assessed as being at high risk of prostate cancer.

Using the standard biopsy, between 10 and 30 per cent of men with prostate cancer present will be given a negative biopsy result. This is because the standard biopsy is based on inserting an ultrasound probe into the back passage (rectum). A needle is then placed down the shaft of the probe, through the wall of the rectum and into the prostate. The procedure takes place under the guidance of the ultrasound image on a screen. Although this image helps us to measure the size of the prostate, it lacks detail and precision. Needles are inserted in between six and 12 different places, with the aim of ensuring all areas of the gland are sampled. Even in experienced hands, it is inevitable that for some patients, the needle will miss the cancerous sections of the prostate.

By contrast, the template biopsy is different to the standard approach in two ways. The term ‘template’ refers to a plate which is used to provide precise mapping of the prostate. It was originally developed for brachytherapy, during which needles are inserted through holes in the template to exactly position radioactive seeds within the prostate. By using the same template during a biopsy, the urologist is able to accurately map where each tissue sample is taken from and ensure the entire prostate is sampled. The template biopsy is also carried out at a different angle to the TRUS procedure. The needles are inserted through the perineum (the area between the scrotum and anus) which means there is less bleeding and discomfort for the patient.

The angle of a template biopsy also allows for improved sampling of the central and anterior sections of the prostate than a TRUS approach.

Template biopsy was first introduced in America and is gradually being introduced in a small number of specialist urological centres now in the UK. Evaluations of its effectiveness are very promising. One study, entitled Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer¹ involving 140 patients concludes: “Template-guided biopsy potentially produces a higher cancer detection rate and more accurate assessment of grade.”

It is important to note that template biopsy should not be the first line diagnostic test for prostate cancer. For the majority of patients, a TRUS biopsy will be an effective diagnostic tool. But for those high risk patients with repeated negative tests, template biopsy offers an important and valuable new method.