Recent reviews, reports and research relating to prostate biopsy

Transperineal biopsy may have temporary erectile dysfunction. This is also a report on a single small study, written by Jody Charnow, reported in the 19 May 2014 online version of Renal & Urology news. Charnow states: “Transperineal prostate biopsy is associated with significant short-term erectile dysfunction (ED), according to study findings presented at the American Urological Association 2014 annual meeting. Erectile function recovers fully by 6 months post-biopsy...The potential impact of transperineal biopsy on erectile function should be emphasized during the informed consent process, the authors concluded.” The article can be read here or here: http://tinyurl.com/kkpt39x

The role of transperineal template prostate biopsies in prostate cancer diagnosis in biopsy naïve men
. Article by S Nafie et al dated 4 March 2014. Conclusion: “TPTPB (transperineal template prostate biopsy) is associated with a significantly higher prostate cancer detection rate than TRUS (transrectal ultrasound guided) biopsies in biopsy naïve men with a benign feeling DRE and PSA <20 ... PSA appears to be better biomarker than previously thought.” Read the article here or here: http://tinyurl.com/kbbonoh

Transperineal prostate biopsy trumps TRUS. Article by Delicia Yard dated 8 January 2014. Conclusion: “Transperineal template prostate biopsy (TPTPB) identifies tumors of a smaller size and earlier stage than transrectal ultrasound (TRUS)-guided biopsy, suggesting that TPTPB may be a far more ideal diagnostic test for localized prostate cancer, researchers reported online ahead of print in the World Journal of Urology.” Read the article here or here: http://tinyurl.com/kxshnll

Transperineal biopsy Vs transrectal biopsy.
In a number of recent articles, reference is made to a significant and increasing risk of infection associated with the TRUS (Trans-Rectal UtraSound guided) biopsy procedure. An alternative to that procedure is the transperineal (TP) biopsy. A recent article by Jeremy Grummet et al in BJUI dated 19 February 2014 provides an evaluation of the two approaches. The article is entitled “Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy?”. The article can be read here or here: http://tinyurl.com/kl3vuur The authors provide these results and conclusions:
  • In all, 245 TP biopsies were performed (111 at Alfred Health, 92 at Epworth Healthcare, 38 at Peter MacCallum Cancer Centre, and four at other institutions).
  • The rate of hospital re-admission for infection was zero.
  • The literature review showed that the rate of sepsis after TRUS biopsy appears to be rising with increasing rates of multi-resistant bacteria found in rectal flora, and is as high as 5%.
  • However, the rate of sepsis from published series of TP biopsy approached zero.
  • Both local and international data suggest a negligible rate of sepsis with TP biopsy.
  • This compares to a concerning rise in the rate of sepsis after TRUS biopsy due to the increasing prevalence of multi-resistant bacteria in rectal flora.
  • Although TRUS biopsy is convenient, cheap and quick to perform, we think that TP biopsy should now be offered as an option, not only to patients undergoing repeat prostate biopsy, but to all patients in whom a prostate biopsy is indicated.
Transperineal biopsy of the prostate. In a Nature Reviews Urology article of December 2013 is reported an abstract of a review by D T S Chang et al comparing the traditional TRUS-guided and the newer transperineal prostate biopsy procedures. The abstract states: "Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved sampling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy." The article is here:
http://www.nature.com/nrurol/journal/v10/n12/full/nrurol.2013.195.html or here: http://tinyurl.com/ns2bhde