Men who need a prostate biopsy should be offered the transperineal (TP) approach as a possible alternative to transrectal ultrasonography (TRUS)-guided biopsy because the former is associated with a much lower risk of sepsis, researchers in Australia concluded.

Jeremy P. Grummet, MBBS, MS, Adjunct Senior Lecturer, Department of Surgery, Monash University, Melbourne, and colleagues analyzed the outcomes of 245 TP biopsies and found a zero rate of hospital re-admission for sepsis, according to an online report in BJU International.

In a review of the medical literature, Dr. Grummet’s group found that the rate of sepsis after TRUS biopsy appears to be rising, with increasing rates of multidrug-resistant bacteria found in rectal flora. The rate of sepsis found in published series of TP biopsy approached zero, they noted. In a total of 6,609 patients, only five (0.076%) were re-admitted to a hospital for sepsis.

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The investigators explained that TP biopsy typically has been reserved for patients undergoing repeat biopsy, either as part of active surveillance for low-risk prostate cancer or for a rising PSA level despite a negative TRUS biopsy.

The TP approach has some drawbacks that have prevented more widespread use, they pointed out. It usually requires a general anesthetic, takes longer to perform, and typically involves taking more cores. Consequently, TP biopsy is more costly than TRUS biopsy.

The investigators concluded that “in today’s environment of rising rates of TRUS-biopsy sepsis and antibiotic resistance, we think that the risk-benefit ratio has now shifted sufficiently to warrant offering TP biopsy as an option to all men in whom a prostate biopsy is indicated.”

A shift to using TP biopsy is likely to have a significant impact on health resources, the researchers said. “Whilst the procedure of TP biopsy alone is clearly more costly than TRUS biopsy, the savings from its lack of infective complications must also be considered,” they wrote.