








































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2023 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

SIUJ  •  Volume 4, Number 3  •  May 2023 SIUJ.ORG

Key Words Competing Interests Article Information

Prostatic neoplasm, needle biopsy,  
neoplasm metastasis, prostate-specific 
antigen, early detection of cancer

See Acknowledgements.

Patient Consent: Obtained.

Received on October 28, 2022 
Accepted on November 6, 2022 
 
Soc Int Urol J. 2023;4(3):232–233

DOI: 10.48083/ZHVJ6978

232

CLINICAL PICTURE

The Prostate Problem You Can’t Put Your Finger on 
the Normal Way: A Case of Perineal Prostate Cancer 
Post Transperineal Prostate Biopsy
Kevin Yinkit Zhuo,1,2 James Kovacic,1,2Amanda Chung,1,2,3 Thomas Eade,3,4 Venu Chalasani,1,2,3

1 Department of Urology, Royal North Shore Hospital, Sydney, Australia 2 North Shore Urology Research Group, Sydney, Australia 3 University of Sydney, Sydney, Australia 
4 Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia

Transperineal biopsy needle-tract tumour seeding is a rare complication, with sparse published literature[1].   
We describe the management of metastatic prostate cancer secondary to transperineal biopsy needle-tract seeding.

An 80-year-old male presented with an otherwise asymptomatic, hard perineal mass that had progressively 
enlarged over a few months. The patient’s urological history included prostate adenocarcinoma of the right prostatic- 
apex, prostatic urethra, and lymph nodes (ISUP-Grade 4 [4 + 4 = 8], PIRADs-5, PSA-level 2.7µg/L), diagnosed via  
transperineal biopsy and TURP 3 years prior. His prostate cancer was definitively managed with TURP, ADT, and 
radiotherapy with a post-treatment PSA-level of 0.05µg/L.

On pelvic examination, a perineal 2cm fixed lump was palpable. Pelvic-MRI demonstrated a 20mm irregular mass 
in the perineal fat immediately below the penile base (Figure 1A). Repeat PSA-level was 6.0µg/L. Subsequent PSMA 
PET-scan revealed a PSMA-avid lesion in the perineal midline, consistent with prostatic neoplasm metastasis without 
other metastatic disease (Figure 1B). Cystoscopy showed no obvious urinary-tract cancer recurrence.

The patient’s case was discussed in a multi-disciplinary team meeting and excision was recommended. The patient 
then underwent a wide-local excision, requiring partial resection of bulbar-spongiosum (Figure 1C). Histopathology 
revealed a complete excision of his prostate adenocarcinoma metastasis, with post-excision PSA-levels of 0.12µg/L.  
No adjuvant therapies were given.

Needle-tract seeding following transperineal prostate biopsy is rare and should not preclude patients from under-
going biopsies. This case highlights the need for patient follow-up after cancer treatment and exemplifies the practi-
cality of PSMA PET-scans if there is evidence of rising PSA-levels after definitive prostate cancer treatment.

Acknowledgements
Competing interests: Dr Amanda Chung: Proctor for Medtronic and Boston Scientific. The other authors have no 
competing interests.

Reference

1. Volanis D, Neal DE, Warren AY, Gnanapragasam VJ. Incidence of needle-tract seeding following prostate biopsy for suspected cancer: a review of the 
literature. BJU Int.2015 May;115(5):698-704.

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SIUJ.ORG SIUJ  •  Volume 4, Number 3  •  May 2023

FIGURE 1A.

Pelvic-MRI. Mass in perineal fat abutting fascia around inferior corpora spongiosis.

FIGURE 1B.

PSMAPET (ongoing resolving right prostatic posterolateral peripheral zone and equivocal  
left pre-sacral node uptake. New PSMA-avid lesion in the perineal midline (SUV-max 21.7)

FIGURE 1C.

Intraoperative image demonstrating perineal metastatic lesion abutting bulbospongiosus.  
The urethra, however, was clear of disease.

1C1B1A

PSMA- avid lesion abutting fascia around inferior 
corpora spongiosis in perinael midline Lesion Bulbospongiosus

233

The Prostate Problem You Can’t Put Your Finger on the Normal Way: A Case of Perineal Prostate Cancer Post Transperineal Prostate Biopsy

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