In advance of my presentation at the American Urological Association’s annual 2023 conference in Chicago, on Saturday, April 29, as part of the Patients Perspective Program (see my announcement and topic in the previous post), I have just perused the newly-released Prostate Cancer: Early Detection Guideline and, while I have yet to finish, I am disappointed at a conclusion reached regarding the efficacy of the transperineal over the transrectal biopsy. The full transcript can be read HERE. The paragraphs referencing the two types of biopsies appear under the headline “Biopsy Technique.”

In short, the authors suggest no “significant” difference in cancer detection rates between the two approaches in patients with suspected GG2+ prostate cancer. However, they note that transperineal biopsies may be more effective in detecting anterior and apical cancers and may have a lower risk of infection. They suggest that future research should investigate unanswered questions regarding the diagnostic capabilities, risks of infection, and value of antibiotic prophylaxis for each approach.

I wonder what research and data will be enough to move the needle toward urologists making transperineal (TPUS) biopsies their best practice in the United States. In my transperineal series below, I cite numerous studies on the less risky nature of the TPUS, discussions regarding the over-use of antibiotics, and how the free-hand PrecisionPoint Transperinneal Access System obviates the need, in most cases, for the administration of antibiotics. It is well known that TPUS is way more effective in detecting clinically significant cancer in the anterior section. Why the hesitancy, especially when patients are ASKING their urologists for this biopsy if needed?

Perhaps this #AUA23 conference would be an excellent place to continue this discussion. I’d encourage more patients to make their voices known as they did in Australia, where urologists are paid less for utilizing the transrectal technique over TPUS (for which they get an incentive).

You can start with all the authors, contributors, and commenters listed at the end of the guideline.

And read my latest entry focusing on the differences between grid based and FH biopsies with some commentary from Matthew Allaway, MD on his PPTAS invention (below).

More commentary on the release of this Prostate Cancer: Early Detection Guideline soon.