A recent study shows more complications with the alternative prostate biopsy method.
If a prostate cancer screening test produces an abnormal result, the next step is usually a biopsy. In the United States, this is almost always done by inserting a biopsy needle into the prostate through the rectum. By looking through an ultrasound machine, doctors can see where the hand is going. This procedure, called transrectal ultrasound biopsy (TRUS), carries a small but growing risk of infections which, in turn, are increasingly resistant to current antibiotics.
To minimize the risk of infection, doctors can also pass the
biopsy needle through an area of skin between the anus and the scrotum called
the perineum, thereby avoiding rectal bacteria. These so-called transperineal
(PT) biopsies offer an additional advantage because they allow better access to
the prostate's tip (or apex), where 30% of cancers occur. However, they
are also more painful for the patient. Until recently, they were only performed
in operating rooms of hospitals under general anesthesia.
Today, technical advances allow physicians to perform PT
biopsies under local anesthesia in their own offices. And with this
development, the pressure is mounting to limit infections by taking this
approach.
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In a recent study, Harvard scientists looked at how the two
methods stack up in cancer detection and complication rates. A total
of 260 men were included in the study, each one very similar in terms of age,
race, PSA levels, and other diagnostic findings. Half of the men had TRUS
biopsies, and half had PT biopsies, and all procedures were performed in a
single doctor visit between 2014 and 2020. According to standard clinical
protocols, all men in the TRUS group received took prophylactic antibiotics to
prepare. In contrast, only 43% of men in the TP group took antibiotics,
depending on the doctor's preference.
Regarding complications, a man in the TRUS group developed
an infection treated with several rounds of oral antibiotics. None of
the men who had a PT biopsy contracted a disease. Still, eight of them had
other complications: one had blood clots in the urine, which were treated in
hospital, two were catheterized for acute urinary retention, three were
assessed medically for dizziness, and two had temporarily swollen blood clots from
the scrotum.