If a prostate cancer screening test produces an abnormal result, the following step is normally a biopsy. In the United States, this is sort of at all times done by inserting a biopsy needle into the prostate through the rectum. Doctors can see where the needle goes by taking a look at the ultrasound machine. Called a transrectal ultrasound (TRUS) biopsy, the procedure comes with a small but increased risk of infections which might be in turn increasingly immune to current antibiotics.
To minimize the danger of infection, doctors may thread the biopsy needle through a patch of skin between the anus and the scrotum called the perineum, thereby bypassing rectal bacteria. These so-called transperineal (TP) biopsies offer one other advantage in that they supply higher access to the tip (or top) of the prostate, where 30% of cancers occur. However, also they are more painful for the patient. Until recently, they were only performed under general anesthesia in hospital operating rooms.
Today, technological advances are making it possible for doctors to perform TP biopsies of their offices under local anesthesia. And with this development, the pressure to limit infection by adopting this approach is increasing.
Results showed minimal differences in cancer detection rates, which were 62% within the TP group and 74% in men undergoing TRUS biopsy. But importantly, 15 percent of men with cancer within the TP group had peak tumors that the TRUS biopsies “would have missed,” the study authors wrote.
Further complications with the TP approach
As for complications, one man within the TRUS group developed an infection that was treated with multiple rounds of oral antibiotics. None of the lads who underwent TP biopsies developed infections, but eight of them had other complications: one had blood clots within the urine that were treated in hospital, two underwent catheterization for acute urinary retention. performed, three were clinically evaluated for dizziness, and two were transient. Swelling of the scrotum.
Why was the speed of TP non-infectious complications high? It is just not in any respect clear. For quite a lot of reasons, doctors stopped taking more prostate samples (called cores) from men within the TP group than from men within the TRUS group, on average. The authors suggest that if an equal variety of men in either group had been covered, the complication rates may need been more similar. (In fact, large comparative studies conducted in hospital-based settings show no difference in complication rates when equivalent numbers of cores are obtained). But the doctors in the present study also had more experience with TRUS biopsies, and this will also explain the discrepancy, the authors suggest. And as doctors normally turn out to be more experienced with TP procedures, complication rates can drop.