Maryland Urologist, Founder of Perineologic Develops Safe Approach to Prostate Cancer Biopsy

For the past 30 years, screening for prostate-specific antigen (PSA) levels has been the gold standard for screening of prostate cancer. When high levels are found, physicians typically turn to a diagnostic biopsy using a transrectal route. However, a Maryland urologist has developed a different approach through the perineum, the strip of skin between the rectum and scrotum that is safer and more effective.

Transrectal biopsies have several drawbacks, including the risk of infection due to the passage of the biopsy needle through the fecal contaminated rectal wall more than a dozen times and accuracy issues due to the inability to effectively reach the entire prostate. To overcome these obstacles, Dr. Matthew J. Allaway, a Maryland urologist, designed a new approach that completely avoids the rectal wall by passing the biopsy needle through the perineum. The approach, dubbed the PrecisionPoint™ Transperineal Access System, has been cleared by the U.S. Food and Drug Administration and requires two needle sticks in the perineum and can be performed in an office setting under local anesthesia.

Allaway launched Cumberland, Maryland-based Perineologic, a medical device company, to market PrecisionPoint. Since the launch, Allaway, who serves as founder and president of the company, said he has received significant support from the Maryland Department of Commerce for its mission.

“With our methodology, we’re able to precisely sample the entire prostate zone, which provides for greater accuracy,” Allaway said.

When the transrectal biopsy became the gold standard in the 1980s, there was no effective technology to perform the transperineal biopsy, Allaway said. With PrecisionPoint, urologists have the capabilities of detecting cancer in even the most difficult to reach parts of the prostate, he added.

Although performing a prostate biopsy through the perineum is not a new concept, Allaway’s approach is streamlined, by requiring fewer core samples, less risk of urine retention, and tolerated by the patient under local anesthesia. Initially, he developed the method for his own practice, but when he saw the dramatically increased cancer detection and elimination of infectious complications, he wanted to “get the word out.” And so far, the word is spreading. The PrecisionPoint System is now available in 29 states across the U.S. and in 13 different countries. Allaway said 14 of the top 15 academic institutions as rated by U.S. News and World Report are using his program.

Not only is it effective in reaching all spots of the prostate, but the PrecisionPoint System is also safer than the traditional transrectal approach.

“The immediate benefit of the transperineal approach is the safety aspect,” Allaway said. With the transrectal approach, the biopsy needle goes through the rectal wall, which means the needle is pushing microscopic amounts of fecal material in the different spots where samples are taken.

Jim Kidd, a retired professor of education from James Madison University in Virginia and patient of Allaway, recounted his experiences with both a transrectal approach and with the PrecisionPoint System. After increased levels of PSA were detected by his doctor, Kidd underwent a transrectal biopsy. No cancer was detected with that procedure. However, when Kidd returned to his physician for a follow-up, his PSA levels had climbed even higher. Concerned, Kidd reached out to other urologists and learned of Allaway’s perineum approach, which was something he opted to try.

Kidd made an appointment with Allaway and drove to Maryland to see him. Allaway conducted the biopsy using the PrecisionPoint System and found cancer in the prostate. Although concerned over the news, Kidd said he was encouraged because cancer was found while it was still treatable. He is currently undergoing radiation treatments and is hopeful the cancer will be arrested. So far, he’s pleased with the progress of his treatment and said he remains active.

“If the cancer hadn’t been found, I would have gone on with the idea I didn’t have cancer. It wasn’t pleasant to learn I had cancer, but I was relieved that it was found and that treatment was available,” Kidd said.

Given the PSA levels, Allaway suspected the PrecisionPoint approach would reach areas of the prostate the other procedure did not. He said Kidd’s prostate was the size of a small grapefruit, but most of it was benign. However, cancer was found using his method.

Allaway said he hopes more physicians will be trained to perform a transperineal approach for prostate cancer biopsies. His company is now training more urologists across the country in the method. However, he noted that for doctors who adopt this approach, there are typically some upfront expenses for new equipment, specifically a new ultrasound probe that can run up to $20 thousand, he said. 

Since the discovery of his cancer, Kidd said he has remained active, playing golf about five days per week, and is also sharing his experiences with the PrecisionPoint System with his friends.

“My friends, we’re all in the same age group and we all have the same concerns. I’ve told them that if they need a biopsy for prostate cancer, you find someone who will do the transperineal biopsy,” Kidd said.