September 2024

UROLOGY

NORTHWESTERN MEDICINE STUDY ADVOCATES FOR ALTERNATIVE BIOPSY APPROACH FOR DETECTING PROSTATE CANCER

The study in JAMA Oncology found that transperineal prostate biopsy had similar cancer detection, but no infections when compared to transrectal biopsy.

​Currently, the predominant approach to prostate biopsy is transrectal prostate biopsy, which removes suspicious tissues from the prostate gland using a needle inserted through the rectum. This “contaminated” technique can introduce bacteria into the prostate, urinary tract and blood stream, thus routinely requires postoperative antibiotics to prevent infection, a practice that increases antimicrobial resistance.
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Suggesting a new standard of care

A Northwestern Medicine study in JAMA Oncology suggests an alternative approach, a percutaneous, transperineal prostate biopsy, is as effective at detecting cancer as the transrectal approach, but without the risk of infection or need for prophylactic antibiotics.
 
“While the potential advantages to the transperineal approach have been suggested, high-level Category 1 evidence was limited,” says primary investigator Edward Schaeffer, MD, PhD, The Harold Binstein Professor and Chief of Urology at Northwestern Medicine. “This study shows that transperineal prostate biopsy without antibiotic prophylaxis significantly is associated with a lower risk of infection compared to transrectal biopsy with targeted prophylaxis. Our data supports a transperineal approach to prostate biopsy as a new standard of care.”
The paper reports the results of the PReclude infection EVEnts with No prophylaxis Transperineal (PREVENT), a 10-center randomized controlled trial that compares the infectious complications of clinic-based transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis. The primary outcome of the study was infection, but researchers also considered outcomes including cancer detection, urinary retention and bleeding.
 
In the trial, 875 participants with suspicion for prostate cancer were randomized. Of those, 382 underwent transperineal prostate biopsy without antibiotics, and 370 participants undergoing transrectal biopsy with antibiotics. No infections were reported in the transperineal arm compared to six, or 1.6%, transrectal biopsy infections. There was no compromise in the detection of high-grade cancer with the transperineal approach (55% vs. 52% of TP and TR biopsies) and rates of other complications were very low and similar.
 
Leading the field

“Antibiotics are a limited, but essential resource. The more widely antibiotics are used, the less likely they will be effective in the future. With this in mind, we have a responsibility to find alternative approaches to patient care that limit risk of infection while decreasing reliance on antibiotics,” says Dr. Schaeffer. “By transitioning to the transperineal approach as the primary technique to prostate biopsy, we can effectively and safely detect cancer while eliminating the need for antibiotics and improving antibiotic stewardship.”
 
Northwestern Medicine is consistently recognized as a national leader in urology at the forefront of research and medical advances in prostate cancer care. Polsky Urologic Cancer Institute at Northwestern Medicine includes a comprehensive prostate cancer program. The program provides a point for patients to access prostate cancer treatments as well as resources like genetic counseling. ​

By bolstering promising active research while strengthening tracking and diagnostic techniques, the program offers precision diagnoses and breakthrough treatments. Thanks to a holistic approach, the team also supports patient well-being through survivorship and follow-up care services.
Dr. Schaeffer's talks with CBS Chicago about the discoveries made in this study.
This study was also featured in Urology Times.
Edward M. Schaeffer, MD, PhD, Chair of Urology and the Harold Binstein Professor of Urology at Northwestern Medicine

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