Novel Prostate Biopsy Technique Lowers Infection Risk

Prostate biopsies are crucial for diagnosing prostate cancer, with approximately 3 million procedures performed globally each year. In the U.S., about 90% of these biopsies are conducted through a transrectal procedure. However, studies indicate that 5% to 7% of patients develop infections following this procedure, and 1% to 3% require hospitalization due to complications. To minimize infection risk, doctors typically prescribe a course of antibiotics before the biopsy. Now, a newer technique for collecting prostate biopsy samples has been shown to lower the risk of infection compared to traditional biopsy methods.

A multi-institutional clinical trial led by researchers at Weill Cornell Medicine (New York, NY, USA) and New York-Presbyterian (New York, NY, USA) evaluated a technique called transperineal prostate biopsy. In this procedure, prostate tissue is collected through a needle inserted into the perineum—the area between the rectum and the scrotum—while using local anesthesia to numb the region. This method avoids the infection-prone transrectal route, where the biopsy needle is inserted through the rectum. The study reported no infections among 382 men who underwent the transperineal procedure, compared to six infections (1.6%) among 370 men who received the traditional transrectal biopsy. This lower infection rate is especially notable because the men in the transrectal group were given a targeted course of antibiotics to mitigate infection risk, while those in the transperineal group received no antibiotics.

Image: Transperineal prostate biopsy reduces risk of infection compared with traditional biopsy approaches (Photo courtesy of 123RF)

For patients undergoing the transrectal biopsy, the researchers implemented a personalized approach to antibiotic prophylaxis. Rather than prescribing broad-spectrum antibiotics, they tailored the antibiotics to cultures taken from the patient's rectum during a prostate exam before the biopsy. According to the study results, published in JAMA Oncology, this targeted antibiotic strategy significantly reduced the infection rate for the traditional transrectal biopsy group compared to national averages. However, the transperineal group achieved even greater success by completely eliminating infections, demonstrating a statistically significant advantage over the transrectal approach.

“Transperineal biopsy should be the new standard of care for prostate biopsy,” said Dr. Jim Hu, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and the director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center. “It was as effective as the traditional transrectal biopsy approach at detecting cancer, but without the risk of infection or the need for antibiotics.”