Research advocate for alternative biopsy approaches to detecting prostate cancer

Prostate cancer is the second most common cancer in American men, and it is estimated that one in eight American men will be diagnosed during their lifetime. Prostate biopsy, a procedure used to detect prostate cancer, is one of the most common invasive diagnostic procedures, with more than 3 million performed annually. Currently, the mainstream approach is transrectal prostate biopsy, which uses a needle inserted through the rectum to remove suspicious tissue from the prostate. This “contaminated” technique can introduce bacteria into the prostate, urinary tract, and bloodstream, necessitating the routine administration of antibiotics postoperatively to prevent infection, which can lead to antibiotic resistance. It will increase.

A new study by researchers at Northwestern Medicine shows that JAMA Oncology have found that using an alternative approach, percutaneous perineal prostate biopsy, is as effective at detecting cancer as the transrectal approach, but without the risk of infection or the need for prophylactic antibiotics. suggests.

“Although potential benefits of a transperineal approach have been suggested, high-level category 1 evidence was limited,” said the principal investigator. Edward Schaefer, MDChair and Professor Harold Binstein urology. “This study shows that transperineal prostate biopsies without antibiotic prophylaxis have a significantly lower risk of infection compared to transrectal biopsies with targeted prophylaxis. Our data support a transperineal approach to prostate biopsy as a new standard of care.”

The paper reports the results Avoiding P infection events without prophylaxis Transperineal (PREVENT) This is a 10-center randomized controlled trial comparing infectious complications of clinic-based transperineal biopsies without antibiotic prophylaxis and transrectal biopsies with targeted prophylaxis. Although the study's primary outcome was infection, the researchers also considered outcomes such as cancer detection, urinary retention, and bleeding.

In this trial, 875 participants with suspected prostate cancer were randomized: 382 to undergo transperineal prostate biopsy without antibiotics and 370 to undergo transrectal biopsy with antibiotics. underwent a targeted biopsy. There were zero infections reported in the transperineal arm, whereas there were six transrectal biopsy infections, or 1.6%. The transperineal approach does not compromise the detection of high-grade cancers (55 percent versus 52 percent for transperineal and transrectal biopsies) and has very low rates of other complications. It was low and similar.

“Antibiotics are a limited but essential resource. The more widely an antibiotic is used, the less likely it is that it will become ineffective in the future. With this in mind, we should reduce our reliance on antibiotics. We have a responsibility to find alternative approaches to patient care that reduce and limit the risk of infection,” Schaeffer said. “Moving to a transperineal approach as the primary technique for prostate biopsy allows us to effectively and safely detect cancer while eliminating the need for antibiotics and improving antibiotic stewardship.” Masu.”

About Northern Western Medicine

Northwestern Medicine is consistently recognized as a national leader in urology at the forefront of prostate cancer research and medical advances. Polsky Urologic Cancer Institutes' comprehensive prostate cancer program provides personalized, integrative, and innovative care for the diagnosis, treatment, and management of prostate cancer. Northwestern Medicine's Prostate Cancer Program provides multidisciplinary access points for prostate cancer treatments, including surgery, chemotherapy, and radiation, as well as resources such as genetic counseling. The program will strengthen promising and active research while enhancing advanced tracking and diagnostic technologies to deliver accurate diagnosis and treatment, breakthrough innovations in treatment and prevention, and survivorship and follow-up care services. We provide sustained health beyond diagnosis and treatment.

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