Improved Clinical Advantages of Transperineal Prostate Biopsies - With Dr. Craig Rogers

Dr. Craig Rogers recently performed two prostate biopsies at Henry Ford Medical Center using CIVCO’s TP Pivot Pro, a disposable needle guide that enables a freehand, minimally invasive approach to ultrasound-guided transperineal prostate biopsies (TPBx). While filming these two procedures – one a targeted, systematic prostate biopsy, the other a systematic prostate biopsy - Dr. Rogers walks us through the reasons why he has chosen to adopt the freehand, minimally invasive technique when performing transperineal prostate biopsies. This blog breaks down his experience with TP Pivot Pro, as well as the “why” behind his adoption of the transperineal approach as a standard biopsy method in his practice. 
TP Pivot Pro Hero Shot
In implementing a freehand, minimally invasive approach to TPBx, Dr. Rogers champions patient safety by mitigating post-biopsy complications while also improving sampling access to all zones of the prostate. By prioritizing precision and reproducibility, Dr. Rogers demonstrates how TP Pivot Pro can improve biopsy procedures, enabling comprehensive sampling of challenging areas like the anterior zone. 

Dr. Craig Rogers also adopted the freehand, minimally invasive approach to ultrasound-guided transperineal prostate biopsies because of its reduced infection risk for his patients. 

"The standard technique that many urologists learn [is] the transrectal prostate biopsy [technique which] comes at a cost … “If you have a million biopsies a year in the U.S. and up to 1-2% of those are going to get a serious infection, [to the point] where they could even end up in the hospital or in an ICU, that - to me - is just unacceptable, [and] even unethical, to be offering that. So we do this technique simply for safety for patients.“ 5

The transperineal biopsy not only significantly reduces post-biopsy complications for the patient, especially urosepsis, but it can also be done without administering quinolone antibiotics. 3  

“Because we're not going through the rectal wall, we don't have the same needs for antibiotics. In fact, we routinely do these with no antibiotics, unless a patient has a history of urinary tract infections [or] if they had had a previous infection with a biopsy will give it. [However], routinely, we're not, so we feel like we're being better stewards of antibiotics [by] not promoting antibiotic resistance. So yet another advantage of this approach.” 5

Dr. Rogers also uses the TPBx approach to improve sampling access to all areas of the prostate, including the anterior zone, which - according to a recent literature review on biopsy techniques - allows for better detection of clinically significant disease and anterior tumours.
TP Pivot Pro Workflow 6
“I feel [it’s] just easier [to] access different parts of the prostate like the anterior prostate…critical to this technique is using a guide that aligns the needle with the array [of] a biplane ultrasound probe… CIVCO’s TP Pivot Pro guide allows us to accurately align our biopsy needle with the array so we're staying on target, even as we're angling the probe to different parts of the prostate.” 5 

According to Dr. Rogers, transperineal biopsies are reproducible to the point where they can be done by residents and fellows in the clinic:

“From an educational standpoint, [it’s important for us] to show that this is a reproducible technique that can be done by our residents [and] by our fellows, just like we would in the clinic. So although this patient is being done in an ASC under sedation, more for medical reasons, we're doing the exact same technique [that] would have been done in the clinic.” 5

Many competing disposable minimally invasive biopsy guides on the market have limitations, in Dr. Rogers’ experience, such as challenges when it comes to secure attachment to the transducer, making it difficult for the needle to stay aligned within the imaging plane. He has also had difficulty accessing the peripheral zone with other products. 

“[With] the competing product [another disposable freehand guide on the market], I have a harder time getting down low to the peripheral zone, because you're limited by the lowest hole that you can go to. Whereas here [with TP Pivot Pro], you can just pivot down and angle even lower. You're going to have a higher cancer detection rate the lower you are, because you're more in the peripheral zone where most cancers occur and not getting as much transition zone.” 5

Henry Ford Clip 2In summary, TPBx offers improved clinical advantages over TRBx for various reasons: 
  • Evidence shows the transperineal approach can lead to improved outcomes compared to the transrectal approach:
  • Reduces risk of negative patient outcomes such as infection and rectal bleeding 4
  • Significantly reduces post-biopsy complications without quinolone antibiotics, especially urosepsis 3
  • Greater sampling of the anterior zone of the prostate 2
  • Better detection of clinically significant disease and anterior tumours 1
Consider using CIVCO’s TP Pivot Pro™ to elevate TPBx in your practice. TP Pivot Pro features a pivoting, minimally invasive coaxial needle that reduces the total number of puncture sites required through the perineum. This pivoting feature allows urologists to perform freehand, minimally invasive biopsies with a disposable needle guide that improves stability, needle visualization and sampling access of the entire prostate, including the anterior zone where prostate cancer is frequently diagnosed. 

To see the procedures at Henry Ford Medical Center and hear Dr. Roger’s experience first-hand, visit

1. Devetzis., Recent Advances in Systematic and Targeted Biopsies ( 
2. Meyer., Transperineal Prostate Biopsy Improves the Detection of Clinically Significant Prostate Cancer among Men on Active Surveillance (The Journal of Urology) 
3. Stefanova., Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability (, National Center for Biotechnology Information) 
4. Panzone., Transrectal Ultrasound in Prostate Cancer: Current Utilization, Integration with mpMRI, HIFU and Other Emerging Applications ( 
5. “Systematic Transperineal Prostate Biopsy Using TP Pivot Pro Guide by CIVCO – Dr. Craig Rogers – Henry Ford Medical Center”