December 2023

UROLOGY

THE PREVENT RANDOMIZED TRIAL: EVALUATING TRANSPERINEAL VS. TRANSRECTAL BIOPSIES

Featuring: Edward M. Schaeffer, MD, PhD; Anthony J. Schaeffer, MD; Shilajit D. Kundu, MD; Ashely E. Ross, MD, PhD; and Hiten D. Patel

​A group of physicians from the Northwestern Medicine Department of Urology, including co-primary investigator Edward M. Schaeffer, MD, PhD, chair and Harold Binstein Professor of Urology, participated in a multi-site randomized clinical trial funded by the National Cancer Institute. The study aimed to compare the outcomes of transperineal biopsy without antibiotic prophylaxis to transrectal biopsy with targeted prophylaxis.

Published in European Urology, this trial randomized 658 participants from 10 centers with elevated PSA and/or abnormal digital rectal exam who had not undergone prior biopsy and had suspected prostate cancer on MRI. The primary outcome was post-biopsy infection. Secondary outcomes included cancer detection, noninfectious complications and pain/discomfort ratings.

The study found that there were zero infections in the transperineal group compared to four infections (1.4%) in the transrectal group. The rates of other complications were low and similar between the two groups. Clinically significant cancer detection was also similar between the groups. Participants in the transperineal group experienced slightly more pain during the procedure, but the effect was small and resolved within seven days.

Transperineal prostate biopsy is a newer approach to biopsy that is performed in the clinical setting with local anesthetic. Previously, clinicians typically performed this procedure in the OR with sedation or anesthesia.

The study demonstrates that office-based transperineal biopsy:
  • Is tolerable
  • Does not compromise cancer detection
  • Does not result in infectious complications

Transrectal biopsy with targeted prophylaxis achieved similar infection rates, but it requires rectal cultures and careful antibiotic selection and administration before biopsy. Clinicians should consider these factors and antibiotic stewardship during decision making.
​
Read the full study here. 
Edward M. Schaeffer, MD, PhD, ​Chair and the Edmund Andrews Professor of Urology at Northwestern Medicine

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