VAIL, CO USA (UroToday.com) - Introduction: It is easy to find 5 septic deaths following transrectal ultrasound guided biopsy. Just punch in ‘prostate biopsy death’ into Pub Med and you will find them.
The urology literature and meetings is filled with earnest presentations about steps taken to reduce the rate of sepsis e.g., look for resistant organisms. The author has taken the easy path to ‘no sepsis.’ He never joined the rush to transrectal ultrasound guided biopsy; he simple stuck with the transperineal route guided by the rectal finger aimed at nodules as had been customary at his urology residence in 1969-1973.
Methods: the private office business computer program was queried for prostate biopsy and evidence of sepsis. The method itself features the ‘skinny’ biopsy needle placed transperineally. The gloved finger in the rectum senses its tip as it approaches the typical stony hard nodule. 2-‐3 samples are taken of the nodule. Usually one or two cores are taken from the opposite lobe of the prostate. The compressed true prostate outside the inevitable adenomata of BPH of the PSA era is biopsied selectively. Pre-‐op anti-‐biotic, usually Ancef, was administered in the last 2 years of the series because of pressure from quality assurance. In the case of suspected high grade anaplasia with no clear borders, a maximum of 6 cores are taken in both lobes.
Results: 85 patients were identified. No evidence of sepsis/prostatitis was found.
Conclusion: the old way is the best way; the rush to the trans-‐rectal biopsy route was unwise. The transperineal route should be re-‐adopted. The needle should be aimed at nodules felt to be firm relative to the rest of the prostate. Those who adopt this recommendation will look good to ‘affordable care’ organizations.
- Horan, A.H. How to Avoid the Overdiagnosis and Overtreatment of Prostate Cancer. On the Write Path Publishing, 5023 W. 120th Ave. #228, Broomfield, CO, 80020, 2012. Available at dranthonyhoranmd.com. p. 35.
Presented by Anthony H. Horan, MD at the 24th International Prostate Cancer Update - February 19 - 22, 2014 - Cascade Conference Center - Vail, Colorado USA