Researchers from around the UK, led by the University of Oxford, have found that a new way of performing prostate biopsies is better at diagnosing prostate cancer, but takes longer to perform and is more painful for patients.
Prostate cancer is the most common cancer in the developed world. The most widely used method of diagnosing prostate cancer involves a biopsy that passes a needle through the lining of the lower bowel (the rectum) and into the prostate gland, which is performed under local anaesthetic. This is called the transrectal route. Researchers and doctors have been looking for ways to improve the needle biopsy process, largely due to the concern of infections from the biopsy process. One option has been to change the route through which the needle passes into the prostate, which would be for it to go through the skin instead of the bowel lining.
In a new trial, published in Lancet Oncology and funded by the National Institute for Health and Care Research (NIHR), researchers recruited 1,126 men from around the UK who were undergoing investigation for possible prostate cancer, and allocated them to receive their prostate biopsy either through the traditional "transrectal" route, or through the skin in the newer "transperineal" route through the skin in the area between the scrotum and the anus. Their goal was to find out which approach was better at diagnosing clinically meaningful prostate cancer which might require treatment, while also recording the impact from complications like infections, difficulties with sexual function, or passing urine. In all cases the biopsies were performed under local anaesthetic in the clinic, and the researchers evaluated how well the patients tolerated the biopsies using patient reported outcomes (PROMs) questionnaires immediately after the biopsy procedure, and for up to 4-months afterwards.
Professor Richard Bryant , the study's Chief Investigator from the University of Oxford's Nuffield Department of Surgical Sciences , presented the new findings at the European Association of Urology's Annual Congress in Madrid this weekend. He said: 'Almost 100,000 men are investigated for prostate cancer every year in the UK, and it is extremely important that we get this right. The results from the trial now provide the evidence necessary to help urologists, and their patients, decide how best to perform prostate biopsy. There have been several excellent trials in this space over the past year with inconclusive results. We have now conducted the largest trial in this field, and are excited to provide definitive results. The results show that transperineal biopsy is better at diagnosing clinically meaningful prostate cancer, and that the men having this type of biopsy did not need antibiotics, which is important to avoid antibiotic resistance. However, it took longer to perform the transperineal biopsies compared to the transrectal route, and men told us that the new biopsy was more painful.'
Dr Alastair Lamb , study co-Lead now at Barts Cancer Institute, Queen Mary University of London , added: 'It is fascinating how activity in medicine and surgery doesn't always follow concrete evidence. Around five years ago many people decided that transperineal biopsy was self-evidently better because of the reduced risk of infection and suspected improved diagnosis. Several hospitals in well-known healthcare systems decided to change their approach wholesale, based on small or non-randomised studies. We now have a big randomised trial showing that, yes, transperineal biopsy is better in certain respects - although perhaps not as much better as we previously thought - but that there are some problems, particularly related to the pain caused by the procedure. Also, in a separate piece of work that we have carried out, we've found that the new biopsy takes longer to perform and is more expensive. There's probably still quite a bit of discussion to have in this space!
'Of course, men anxious about needing a biopsy at some point in the future will be pleased to know the search is under way to find an alternative, less invasive way to diagnose prostate cancer.'
This work now provides concrete evidence regarding the two currently available common techniques for prostate biopsy, to better inform urologists and patients of the relative trade-offs between the two techniques in the detection of prostate cancer.
The full paper, ' Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial ,' is published in Lancet Oncology .
