New biopsy technique reduces risk of infection in prostate cancer diagnosis

A clinical trial conducted at several Weill Cornell Medicine and NewYork-Presbyterian research centers found that a new technique for sampling prostate biopsies reduced the risk of infection compared to traditional biopsy techniques.

The results of the study were published in the journal JAMA Oncology.

The technique, called transperineal prostate biopsy, involves taking prostate tissue with a needle through the skin of the perineum – the area between the rectum and scrotum. The procedure, which is performed using local anesthesia, allows doctors to bypass the traditional and more infection-prone method of obtaining a prostate biopsy by inserting a needle through the rectum.

The study found no infections among the 382 men randomized to the procedure through the perineum (transperineally), compared with six infections developing in 1.6% of the 370 men randomized to the traditional biopsy procedure through the rectum (transrectally).

The lower infection rate was particularly important because men in the transrectal biopsy group received a targeted course of antibiotics to reduce the risk of infection, while men in the transperineal biopsy group did not receive antibiotics.

The scientists who conducted the study believe that transperineal biopsy should become the new standard for prostate biopsies. It was as effective as traditional transrectal biopsy in detecting cancer, but with no risk of infection and no need for antibiotics.

Prostate biopsy is the most important tool for detecting prostate cancer, and approximately 3 million men worldwide undergo this procedure each year. 5-7% of patients develop infections after a transrectal biopsy, and 1-3% of patients require hospitalization due to complications.

To help prevent infections, doctors usually prescribe a prophylactic course of antibiotics before the procedure.

Researchers took a personalized approach to prophylactic antibiotic administration in patients who underwent a transrectal biopsy procedure. Rather than prescribing broad-spectrum antibiotics or multiple antibiotics to patients, they selected antibiotics according to the results of a culture from the patient’s rectum during a prostate exam before the procedure. This targeted approach to antibiotic use resulted in a significant reduction in infections among patients who underwent the traditional transrectal procedure compared to the nationwide rates of infections caused by the procedure. However, a statistically significant reduction in infections in the transperineal patient group was achieved by eliminating infections altogether.

“Transperineal prostate biopsy makes a common diagnostic procedure safer for men,” said Dr. Hu, study investigator. “It also eliminates the need for antibiotics, helping to reduce the occurrence of antibiotic-resistant infections, which is a growing public health problem.”

Despite the promise of the new procedure, Dr. Hu acknowledged several obstacles to making it more accessible to men. He explained that few doctors in the country have been trained to perform the procedure in the perineal area. In addition, he noted that U.S. insurance companies pay the same amount for any procedure, but transperineal biopsies are more expensive and take longer, creating a financial barrier for physicians.

However, there is reason to believe that this will change, as it did in Norway following the death of a patient after a conventional transrectal prostate biopsy. Biopsy-related infections and deaths have virtually disappeared in that country since the switch to transperineal biopsy.

“There are good reasons for the transition. Of course, it takes time. But as more patients seek the new procedure, it will become more accessible,” Dr. Hu believes.

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Published: 24.09.2024

Updated: 16.10.2024

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak