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Transperineal Biopsies

by Arkansas Urology on Monday, May 04, 2020

Most men are advised to be screened annually or every other year for prostate cancer depending on their age and family history. Screening may consist of a blood test which measures prostate-specific antigen (PSA) and digital rectal exam (DRE). At Arkansas Urology, we are closely following the CDC guidelines and performing only performing urgent and emergent cases as approved by the Arkansas Dept. of Health. These cases may include kidney stones or situations where somebody is unable to urinate or cases in which an increased risk of prostate cancer is time-sensitive. Due to the COVID-19, we are not doing all prostate cancer biopsies right now, but definitely those who are at high risk. To avoid a potential risk of Infection, we are utilizing the transperineal prostate biopsy rather than the standard transrectal biopsies.

When somebody is at high risk of cancer, there may be a need to do a biopsy procedure to find out if the patient has cancer or not. If the patient has a confirmed elevated or rising PSA or an abnormal DRE, the next step is often to proceed with a transrectal ultrasound-guided prostate biopsy. However, due to the risks right now being associated with the coronavirus, we have started doing transperineal biopsies, which goes through the skin directly into the prostate gland, which decreases the risk for infection dramatically. The last thing we want to do is cause an infection and a patient end up in a local ER.

In a transperineal biopsy, the urologist passes the biopsy needle through the perineal skin and into the prostate, rather than passing the biopsy needle through the potentially contaminated rectum which may pose a higher risk of infection. The biopsy needle is still guided by an ultrasound placed in the rectum. Transperineal biopsy is appropriate for all patients, but may specifically benefit patients with the following conditions:

  • History of infection after a previous transrectal biopsy
  • History of prostatitis
  • Inflammatory bowel disease
  • Rectal bleeding complications after previous biopsy
  • Previous negative transrectal biopsy with suspicion of anterior prostate tumor

The main benefit is safety, due to the lower risk of severe life-threatening infection. Also, with a transperineal approach it is much easier to access the anterior prostate, which is not well sampled with transrectal biopsy.

After COVID-19 subsides, we will all be stronger because of what we have gone through as a state, nation and world. In healthcare, I do think a silver lining in all of this will be how many physicians are learning new procedures like this one and being taught new ways to practice medicine like telehealth. I think we will do more transperineal biopsies in the future. While most biopsies will continue to be transrectal, certain patients will be better suited for a transperineal approach.

Many patients who have prostate cancer, may be referred to the Arkansas Prostate Cancer Center, which offers radiation therapy for the treatment of prostate cancer. Patients with prostate cancer also have several treatment options, including: surgery, external beam radiation therapy (EBRT), prostate brachytherapy, hormone therapy, chemotherapy, cryosurgery and watchful waiting.