Dr. Hu on the PREVENT trial of transperineal vs transrectal biopsy

In this video, Jim C. Hu, MD, MPH, discusses the background for the study, “Transperineal Versus Transrectal Magnetic Resonance Imaging–targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial.” Hu is a professor of urology at Weill Cornell Medicine / NewYork-Presbyterian Hospital in New York, New York.

Could you describe the background for this study?

Prostate biopsy is one of the most commonly performed procedures by urologists worldwide given the widespread use of PSA screening, particularly more recently as guideline recommendations have tilted back towards prostate cancer screening. Of course, in men who have an elevated PSA and increasingly then they have a reflex test that is an MRI of the prostate who have an abnormal MRI, then a prostate biopsy is warranted. It's been estimated that 2 million prostate biopsies are performed annually when you look at Europe and the United States in combination. So again, we do this on a fairly common basis. Additionally, with the increased use of active surveillance appropriately in men with low-risk cancer and increasingly intermediate-risk prostate cancer, those men of course, get serial prostate biopsies over time. One of the dreaded complications, which literature reviews as well as meta-analyses have stated, is that a biopsy-related infection occurs in about 5% to 7% of men. The goal of our study was to investigate whether a newer approach to prostate biopsy, that is a transperineal approach, in which there's now been local anesthetic techniques that enable it to be performed in the office setting rather than traditionally it's been performed in an outpatient surgery setting under sedation or anesthesia. We investigated and compared the risk of infection after transperineal MRI-targeted biopsy vs a transrectal MRI-targeted biopsy.

I should also mention that because [in] the transperineal approach, the biopsy needle is inserted through the skin, it's considered a clean percutaneous approach similar to drawing blood or inserting an IV. And therefore, antibiotics may not be needed whatsoever to prevent infection, whereas of course, with the traditional transrectal biopsy, there's a need for antibiotics beforehand. We chose to use targeted prophylaxis in which we did a rectal swab culture, identified whether or not there was resistance to fluoroquinolone antibiotics, and in the presence of that resistance, patients undergoing transrectal biopsy were switched out to an agent that they were sensitive to prior to biopsy. So, that's the background and a little bit about the study designed for the PREVENT trial.

This transcription has been edited for clarity.