Article authored by:
John M. Gunselman, D.O., urologist
Providence Urology Clinic-East
5050 NE Hoyt St., Suite 210
Portland, OR 97213
For men with a suspected prostate cancer diagnosis, the next step often is undergoing a transrectal prostate biopsy. This involves passing a biopsy needle multiple times through the wall of the rectum to obtain samples of prostate tissue. However, the transperineal biopsy – with an updated approach that uses local anesthesia – passes the biopsy needle through the skin of the perineum, often providing better access to the prostate gland. More importantly, it dramatically reduces the risk of infection by avoiding direct fecal contamination of the prostate tissue.
Prostate cancer is the most common solid organ malignancy in men. It remains the second leading cause of death from cancer in men, and it’s estimated that 1 million biopsies are performed in the U.S. annually. This short procedure usually is performed in a urologist’s office with local anesthesia under ultrasound guidance.
New complications with traditional, transrectal biopsies
The transrectal biopsy approach is generally well-tolerated, offers a satisfactory cancer detection rate, is convenient for the patient and clinician, and until recently, had a relatively low risk for infection of less than 1%.
In recent years, however, we’ve seen a surge of infectious complications. Urinary tract infections, including prostatitis, are reported at 1% to 17.5%, with incidence of post-biopsy sepsis rates upward of 2.8% in one large series. Many of these UTIs are linked to an increase in antibiotic resistance patterns. Many urologists attempt to curtail the increased infection risk by offering longer courses of antibiotics or multiple broad-spectrum antibiotics. This in turn increases risk for antibiotic-related side effects and, as a general principle, does not represent good antibiotic stewardship.
Clinical advantages of the transperineal approach
Multiple large series have demonstrated very low (<0.5%) infectious complications associated with transperineal biopsy. As a result, prophylactic antibiotics are not routinely necessary.
In the past there were downsides to performing transperineal biopsy – namely, it was more difficult to perform and required general anesthesia (due to patient discomfort).
But a new device called the PrecisionPoint™ transperineal access system has both simplified the procedure and allowed it to be performed under local anesthesia.
Transperineal biopsies now can be performed in the office under local anesthesia with the same degree of patient comfort, cancer detection efficacy and, most importantly, safety. Providence Urology Clinic East is the only group in the Portland metro area offering transperineal biopsy as its standard approach.
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