A multi-site clinical trial revealed that a new method for gathering prostate biopsy samples lowers the chances of infection compared to standard biopsy methods.
Researchers from Weill Cornell Medicine and NewYork-Presbyterian led a multi-site clinical trial that demonstrated a new technique for collecting prostate biopsy samples significantly decreases the risk of infection in comparison to traditional biopsy methods.
The findings of the research were published on September 19 in JAMA Oncology.
This new technique, known as transperineal prostate biopsy, involves obtaining prostate tissue using a needle inserted through the skin of the perineum, the area located between the rectum and the scrotum. The procedure employs local anesthesia to numb the region, allowing doctors to avoid the conventional and more infection-prone route of taking biopsy samples through the rectum.
The PReclude infection EVEnts with No prophylaxis Transperineal (PREVENT) trial, which was financed by the National Cancer Institute (part of the National Institutes of Health), took place at various locations, including NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian Queens, and NewYork-Presbyterian Brooklyn Methodist Hospital. The study reported no infections among the 382 men who underwent the transperineal procedure, while the conventional transrectal biopsy method resulted in six infections, or 1.6%, among 370 participants. This significantly lower infection rate is noteworthy, considering that men in the transrectal biopsy group were given a targeted course of antibiotics to help lessen their infection risk, whereas the transperineal group did not receive any antibiotics.
“Transperineal biopsy should be the new standard practice for prostate biopsy,” stated Dr. Jim Hu, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center. “It proved to be as effective in detecting cancer as the traditional transrectal biopsy but without the associated infection risk or the need for antibiotics.”
Prostate biopsies are vital for identifying prostate cancer, performed on around 3 million individuals globally each year. Dr. Hu highlighted that approximately 90% of these biopsies in the United States are done using a transrectal method. However, research revealed that 5% to 7% of patients experience infections after the biopsy, with 1% to 3% necessitating hospitalization due to these complications. To mitigate infection risks, doctors typically prescribe preventive antibiotics prior to the procedure.
Dr. Hu noted that the researchers employed a tailored approach to prophylactic antibiotics for patients undergoing the transrectal biopsy. Instead of utilizing broad-spectrum or multiple antibiotics, they matched antibiotic treatments based on cultures collected from the patient’s rectum during prior prostate examinations. This targeted strategy significantly lowered the infection rate in patients undergoing the traditional transrectal biopsy when compared to the national infection rate. Meanwhile, they eliminated infections entirely in the transperineal group.
“Transperineal prostate biopsy enhances the safety of a common diagnostic procedure for men,” Dr. Hu remarked, who is also affiliated with the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine. “Additionally, it removes the reliance on antibiotics, thereby helping to combat the rise of antibiotic-resistant infections, which is a growing public health issue.”
Despite the positive outlook for this new method, Dr. Hu recognized some obstacles that may hinder its widespread implementation in the United States. He pointed out that there are currently few physicians trained in this perineal method. Moreover, he mentioned that U.S. insurance companies reimburse equally for both procedures, but the transperineal biopsy incurs higher costs and requires more time, which can discourage doctors from making the switch.
Nonetheless, Dr. Hu is optimistic about a potential shift in practice, pointing out the transition to transperineal prostate biopsies in Norway following a death linked to a routine transrectal biopsy. This change nearly eradicated biopsy-related infections and fatalities in that country after adopting the transperineal method nationwide.
“There is a compelling case for adopting this new approach,” he stated. “While it will take time, as more patients advocate for the newer method, we anticipate it will become more accessible to everyone.”
