Prostate biopsies taken through the perineum are significantly more effective at detecting clinically-relevant prostate cancer than transrectal procedures, a head-to-head study has confirmed.
The randomised trial found that local anaesthetic ultrasound-guided transperineal biopsy (LATP) had a 6% higher detection rate than transrectal ultrasound-guided biopsy (TRUS), while resulting in fewer infections and similar levels of complications.
However, patients reported more frequently that LTAP was painful and embarrassing, and the procedure took longer to complete.
“These findings will help to inform patients, clinicians, clinical guidelines, and policy makers regarding the important trade-offs between LATP and TRUS prostate biopsy,” the authors stressed, in a paper published in The Lancet Oncology [link here].
The TRANSLATE study recruited 1126 biopsy-naive men with suspected prostate cancer due to elevated PSA, abnormal digital rectal examination or MRI results.
Participants were randomly allocated to receive LATP (n=562) or TRUS (n=564) biopsy, with procedures taking place across ten centres in the UK.
The results showed that clinically meaningful Gleason Grade Group (GGG) 2 or higher prostate cancer was detected in 60% of patients who underwent LATP, compared to 54% of those who underwent TRUS (OR 1.32, p=0.031).
Only one patient (<1%) in the LATP group experienced an infection in the seven days post-biopsy, compared to seven (1%) in the TRUS.
There were also fewer infectious complications in the four months after biopsy in the LATP versus TRUS cohort (six vs 13, respectively).
Across the same period there were also no statistically significant differences between the two groups in reported biopsy-related complications, including urinary retention requiring catheterisation, blood in bowel movements or urine, pain in the biopsy area and hospitalisations.
As a result, 89% of LATP biopsies did not require antibiotics. “Thus, TRANSLATE demonstrates that most LATP biopsies can be safely performed without antibiotics, which is important for antibiotic stewardship,” the authors wrote.
There were also no disparities in urinary symptoms or sexual function at day seven, day 35 or four months post biopsy, while procedure-related symptoms at day seven were more common in patients allocated to TRUS (25% vs 18%).
However, LATP procedures took longer to complete than TRUS, in terms of both time in the room (median 28 mins vs 22 mins) and time to perform biopsy (median 12 mins vs 8 mins).
Patients also more commonly reported LATP as problematic immediately after biopsy (38% vs 27%) as well as “a lot” of procedure-related pain, discomfort and embarrassment.
The authors concluded that the findings “provide the evidence necessary when considering trade-offs and deciding which biopsy to adopt.”
They also back continued use of systemic biopsies versus targeted biopsies of lesions visible on MRI, a subject of continued debate.
Had systemic biopsies been omitted in the study, there would have been lower overall detection of GGG 2 or higher prostate cancer, they noted.
New insight on sexual dysfunction in prostate cancer
Elsewhere, a separate study has highlighted high rates of sexual dysfunction among prostate cancer patients with de novo advanced stage disease and those treated with androgen deprivation therapy (ADT), suggesting clinicians should improve sexual rehabilitation in these groups.
The research, published in Clinical Oncology [link here], analysed the responses of 654 prostate cancer patients to an online survey of physical and psychological sexual dysfunction.
Among respondents, 99% reported new-onset sexual issues following treatment while 78% said sex and sexual activity were fairly or very important to them.
Overall, the most common physical dysfunctions were erectile dysfunction (91%), ejaculatory disturbance (83%), and anatomical penile change (70%), while those of psychosexual nature were loss of sexual confidence (76%), loss of sex drive (67%), and loss of self-esteem (57%), according to the paper.
Patients with de novo advanced stage cancer were significantly more likely to report sexual dysfunction in five out of 13 domains (erectile dysfunction, loss of sex drive, loss of self-esteem, don’t ‘feel like a man’, and too tired for sexual activity), compared to those with localised or locally advanced disease.
Also, ADT was the regime most strongly associated with sexual issues, as patients treated with ADT, radical prostatectomy and radiotherapy (RT) were most likely to report sexual dysfunction in seven of the 13 domains, while those treated with RT + ADT and ADT +/- 2nd line therapy had the highest rates in two and three categories, respectively.
“The findings have significant clinical implications as previous evidence has shown patients with advanced [prostate cancer] are the least likely to be offered support and interventions,” the authors, led by William Kinnaird, a Consultant Urology Therapeutic Radiographer at University College London Hospitals, wrote.
“Clinicians often see advanced disease as a ‘barrier’ to initiating discussions and are less likely to offer interventions. This study demonstrates the need to offer equitable support to patients across disease stages,” they added.