Prostate cancer is the second most common cancer in men in the United States with estimates that one in eight American men will be diagnosed in their lifetime. Prostate biopsy, a procedure to detect prostate cancer, is one of the most common invasive diagnostic procedures with more than 3 million performed annually. Currently, the predominant approach 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.
A new study by Northwestern Medicine investigators published in JAMA Oncology suggests that using 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,” said primary investigator Edward Schaeffer, MD, PhD, the chair and Harold Binstein Professor of Urology. “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) trial, 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 investigators also considered outcomes including cancer detection, urinary retention and bleeding.
In the trial, 875 participants with suspicion for prostate cancer were randomized with 382 undergoing transperineal prostate biopsy without antibiotics and 370 participants undergoing transrectal biopsy with antibiotics. Zero infections were reported in the transperineal arm compared to six, or 1.6 percent, transrectal biopsy infections. There was no compromise in the detection of high-grade cancer with the Transperineal approach (55 percent vs. 52 percent of transperineal and transrectal biopsies) and rates of other complications were very low and similar.
“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,” said Schaeffer, who is also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “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.”
About Northwestern Medicine
Northwestern Medicine is consistently recognized as a national leader in urology at the forefront of research and medical advancements in prostate cancer. The Polsky Urologic Cancer Institute of the Lurie Cancer Center’s comprehensive prostate cancer program offers personalized, integrative and innovative care for the diagnosis, treatment and management of prostate cancer. The Northwestern Medicine prostate cancer program offers a multidisciplinary access point for prostate cancer treatments, such as surgery, chemotherapy and radiation, as well as resources, including genetic counseling. Bolstering promising, active research while strengthening advanced tracking and diagnostic techniques, the program offers precision diagnosis and treatment, groundbreaking innovation in treatment and prevention and sustained wellness beyond diagnosis and treatment through survivorship and follow-up care services.
For more information on prostate cancer care at Northwestern Medicine, visit nm.org/urology or call 833-7-POLSKY (833-776-5759) to make an appointment. To learn more about Northwestern Medicine, visit news.nm.org.
