Expert on single-institution outcomes with transperineal prostate biopsy

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“In this study, we sought to compare our early outcomes with transperineal prostate biopsy compared to transrectal,” says Saum B. Ghodoussipour, MD.

In this video, Saum B. Ghodoussipour, MD, shares the background and key findings from the study, “Transperineal prostate biopsies without routine administration of perioperative antibiotics: A single-institution retrospective analysis.” Ghodoussipour is an assistant professor of surgery in urologic oncology as well as the director of the bladder and urothelial cancer program at Rutgers Cancer Institute of New Jersey.

Video Transcript:

Prostate cancer is the most common condition that we treat in urologic oncology. There's over 1.5 million people each year around the world diagnosed with prostate cancer, over 200,000 people here in the United States. The mainstay in the diagnosis of prostate cancer, aside from screening, which is a whole another controversial subject, is prostate biopsy. We've had a lot of recent advances in our ability to perform accurate prostate biopsies. One of those most important innovations, has been MRI fusion, meaning we get MRIs prior to our ultrasound guided biopsies. But at the end of the day, we still need that ultrasound in order to obtain the tissue for the biopsy. Traditionally, the ultrasound has always been placed in the rectum to visualize the prostate. But traditionally, needles were passed through that ultrasound probe through the rectum into the prostate to sample the tissue. Now that does put patients at risk of infection because the needle is piercing the rectal mucosa, introducing bacteria into the prostate. That risk of infection is up to 5% in series of patients who have received transrectal prostate biopsy, which doesn't sound very high, but given the number of patients who receive prostate biopsy every year, it is a big issue in the United States and worldwide. So, a lot of recent interests and energy has been put forth towards decreasing complications after transrectal prostate biopsy, including the use of targeted antibiotics and also transperineal techniques.

A transperineal prostate biopsy is one in which the needle never pierces the rectal mucosa. We still have an ultrasound probe in the rectum, but needles are placed through the skin directly into the prostate. A few years ago at our institution, we converted to transperineal prostate biopsies instead of transrectal prostate biopsies. In this study, we sought to compare our early outcomes with transperineal prostate biopsy compared to transrectal. With transrectal prostate biopsies, our patients historically all received a bowel prep with an enema prior to the biopsy as well as antibiotic prophylaxis, meaning IV antibiotics or oral antibiotics prior to the biopsy. Whereas our transperineal prostate biopsies had no bowel prep, no enema, and no antibiotics at all.

We looked at 318 patients taken care of at our center, including 173 who had a transrectal prostate biopsy, and 143 who had a transperineal prostate biopsy. Our infection rate in the transrectal cohort was 5.2%–9 patients had an infection, including 8 who required emergency room visits and 4 who had sepsis, or very severe infection–compared to 0 infectious complications in our transperineal cohort, despite the fact that there was no use of antibiotics. These results have been shown in similar studies, including a big randomized control trial that was recently published. But one important difference in our cohort compared to others is that these were not patients who are having their first time biopsy. This included all patients, including men on active surveillance who had multiple prior biopsies; 40% of our patients had had a prior prostate biopsy, which could potentially put you at a higher risk of infection regardless of the approach that you use.

This transcription has been edited for clarity.

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