Our Summary

This research paper reviews a different approach to performing prostate biopsies.

Traditionally, prostate biopsies are done through the rectum, a technique considered the standard method. However, this method carries a risk for infection because rectal bacteria can be transferred to the prostate or bloodstream.

A newer method, called the transperineal biopsy, is being explored. This method involves accessing the prostate through the skin between the anus and scrotum (perineum), which significantly reduces the risk of infection.

Recent findings suggest that the transperineal method also allows for systematic and MRI-targeted biopsy cores, like the transrectal method. But, because there’s less risk of transferring bacteria, it might be possible to avoid using antibiotics before the procedure. This could help reduce the growing problem of antibiotic resistance.

Traditionally, transperineal biopsies are done under general anesthesia. However, it can also be done using local anesthesia or sedation, which could lead to significant healthcare savings, as well as reducing infections and hospital stays.

In summary, the transperineal biopsy method may offer several advantages over the conventional transrectal method and could be a promising way to diagnose and monitor prostate cancer.

FAQs

  1. What is the traditional method of performing a prostate biopsy and what are its risks?
  2. How does the transperineal biopsy method differ from the traditional method and what are its potential advantages?
  3. Could the use of the transperineal biopsy method help reduce the problem of antibiotic resistance?

Doctor’s Tip

A doctor may advise a patient undergoing a prostate biopsy to discuss with their healthcare provider the option of a transperineal biopsy as a potentially safer and more effective alternative to the traditional transrectal method. They may also recommend discussing the possibility of local anesthesia or sedation instead of general anesthesia to reduce costs and potential complications. Additionally, the doctor might suggest following any pre-procedure instructions carefully to ensure the best possible outcome.

Suitable For

Patients who may be recommended for a prostate biopsy include those with:

  • Elevated PSA levels: A prostate-specific antigen (PSA) test measures the level of PSA in a man’s blood. High levels may indicate prostate cancer, although other conditions can also cause elevated PSA levels.

  • Abnormal digital rectal exam (DRE) findings: During a DRE, a doctor inserts a lubricated, gloved finger into the rectum to feel the prostate gland for any abnormalities, such as lumps or hard areas.

  • Suspicious imaging results: If imaging tests, such as ultrasound or MRI, show abnormalities in the prostate gland, a biopsy may be recommended to confirm the presence of cancer.

  • Family history of prostate cancer: Men with a family history of prostate cancer, especially in a first-degree relative (father, brother, son), may be at higher risk of developing the disease and may be recommended for regular screenings and biopsies.

  • Previous negative biopsy results: If a previous biopsy was negative but symptoms or test results persist, a repeat biopsy may be recommended to further investigate the possibility of prostate cancer.

Overall, the decision to recommend a prostate biopsy is based on a combination of factors, including PSA levels, DRE findings, imaging results, family history, and individual risk factors. It is important for patients to discuss their concerns and options with their healthcare provider to determine the most appropriate course of action.

Timeline

Timeline of patient experience before and after prostate biopsy:

Before biopsy:

  1. Patient is referred for a prostate biopsy by their urologist after abnormal prostate-specific antigen (PSA) levels or suspicious findings on a digital rectal exam.
  2. Patient may undergo a consultation with the urologist to discuss the procedure, risks, and benefits.
  3. Patient may be instructed to stop taking blood-thinning medications before the biopsy to reduce the risk of bleeding.
  4. Patient may be prescribed antibiotics to take before the biopsy to reduce the risk of infection.

During biopsy:

  1. Patient arrives at the clinic or hospital for the biopsy procedure.
  2. Anesthesia is administered to numb the area or put the patient to sleep, depending on the method used.
  3. Biopsy samples are taken from the prostate using a needle guided by ultrasound imaging.
  4. The procedure typically takes about 15-30 minutes to complete.

After biopsy:

  1. Patient may experience some discomfort, bleeding, or blood in the urine or semen for a few days after the procedure.
  2. Patient may be prescribed pain medication or antibiotics to manage any discomfort or prevent infection.
  3. Patient may be advised to avoid heavy lifting or strenuous activities for a few days to allow the biopsy site to heal.
  4. Patient will follow up with their urologist to discuss the biopsy results and determine the next steps for treatment or monitoring.

Overall, the transperineal biopsy method offers a potentially safer and more effective alternative to the traditional transrectal method, with potential benefits for both patients and healthcare systems.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostate biopsy include:

  1. What are the risks and benefits of a transrectal biopsy versus a transperineal biopsy?
  2. Will I need to take antibiotics before the biopsy, and if so, why?
  3. What type of anesthesia will be used during the biopsy procedure?
  4. How long will the biopsy procedure take, and will I need to stay in the hospital afterward?
  5. Will the transperineal biopsy allow for systematic and MRI-targeted biopsy cores like the transrectal method?
  6. How accurate is the transperineal biopsy in detecting prostate cancer compared to the transrectal method?
  7. Are there any specific precautions I should take before or after the biopsy procedure?
  8. What are the potential side effects or complications of a transperineal biopsy?
  9. How soon will I receive the biopsy results, and what will the next steps be based on those results?
  10. Are there any alternative diagnostic tests or procedures that could be considered instead of a prostate biopsy?

Reference

Authors: Cheng E, Davuluri M, Lewicki PJ, Hu JC, Basourakos SP. Journal: Curr Opin Urol. 2022 Jan 1;32(1):85-90. doi: 10.1097/MOU.0000000000000947. PMID: 34783715