It avoids infection and unnecessary antibiotic use, and we’re already onto it, even if others are lagging behind.
Australia has been in the forefront of transperineal biopsy for prostate cancer, and the research continues to affirm that path.
But the rest of the world is still catching up, according to the authors of the latest study, published in JAMA Oncology.
“[Globally,] more than 3 million prostate biopsies are performed annually. Transrectal prostate biopsy is the predominant approach used and antibiotics are given routinely to prevent infection, which increases societal antimicrobial resistance,” the authors write.
“Transperineal biopsy should be the standard of care for prostate biopsy.”
The research letter describes a multicentre trial in the US involving 875 participants suspected of having prostate cancer who were having their first biopsy.
The patients were randomised between February 2021 and March 2024 to have either a transperineal biopsy under local anaesthetic without antibiotic prophylaxis, or a transrectal biopsy with targeted prophylaxis.
There were no infections in the transperineal group and six infections, grade 2 and above, in the transrectal group. There were few other complications that required intervention: one case of urinary retention in the transperineal group and four in the transrectal group and one case of bleeding in the transrectal group. In the transperineal group, 55% had a high-grade cancer compared with 52% in the transrectal group.
The prostate biopsy-related infections can be very serious and can often require intensive care, Associate Professor Weranja Ranasinghe, a uro-oncologic surgeon at Monash Health and Austin Health, told Oncology Republic.
“Because of that, there’s been a lot of real-world [evidence?] that’s come out of Australia which has shown that the infection rate with transperineal biopsy is close to 0%. We were probably the leaders in the world to move towards transperineal biopsy; we’ve been doing it for many years.”
In Australia, transperineal biopsies are usually performed under general anaesthetic in a hospital (whereas transrectal biopsies could be performed in an outpatient setting).
“That’s one of the major downsides to transperineal biopsies,” said Professor Ranasinghe.
The procedures are not all that different, he explained.
“The ultrasound probe goes through the rectum. It’s where the biopsy needle passes which makes a difference. In the older transrectal method we used to pass the needle through the rectum, whereas in the transperineal, it’s passed through skin in the perineum between the legs, which has less pathogenic bacteria.
“Some hospitals in Australia can do transperineal biopsies under local anaesthetic, so it’s possible. In the future, the majority of transperineal biopsies are probably going to be done under local anaesthesia. However, patient selection, staff experience and resources are critical in this transition.”
