DEAR MAYO CLINIC: My husband had an MRI that showed an abnormal spot on his prostate. The last time he had a prostate biopsy, he got a severe urinary tract infection, which led to him being hospitalized. It took him weeks to recover. Is he at risk of another serious infection after this prostate biopsy? Is there anything we can do to reduce that risk?
ANSWER: Although it’s uncommon to contract an infection as a result of a prostate biopsy, as your husband found out, it can happen. A new technique for prostate biopsies has been developed, however, that reduces the odds of an infection to almost zero. That technique, called “transperineal fusion biopsy,” is a good alternative to consider, particularly for someone like your husband who has already had one severe infection due to a biopsy.
A prostate biopsy is a procedure that removes samples of suspicious tissue from the prostate gland, so they can be examined for signs of cancer. Until recently, prostate biopsies had to be performed with a probe inserted through the rectum. During the procedure, a needle is passed through the rectal wall to obtain tissue from the prostate. This approach, known as a transrectal biopsy, exposes the biopsy needle to bacteria found in the rectum.
Despite measures to reduce the risk of infection with a transrectal biopsy, such as cleansing enemas and antibiotics, the needle may encounter fecal contents, and bacteria can be introduced into the prostate or bloodstream. The risk of contracting an infection with a transrectal biopsy is about 6%. The risk of requiring hospitalization for urosepsis — a serious infection of the bloodstream — due to a transrectal biopsy is about 3%. In contrast, the new technique — transperineal fusion biopsy — virtually eliminates the risk of infection.
The perineum is the area that lies between the scrotal sac and the anus in men. For a transperineal fusion biopsy, a needle is inserted through the perineal skin while an ultrasound probe in the rectum helps locate the area in the prostate that requires biopsy. When this technique is used, the needle never enters the rectum, virtually eliminating the risk of infection. This technology also uses previously obtained MRI imaging of the prostate to guide the needle to the suspicious region.
After the procedure, there is a small risk of urinary retention or inability to urinate in about 2% of patients, which is similar to the transrectal approach. Unlike the transrectal approach, there is almost no risk of bleeding from the rectum after a transperineal biopsy.
Another significant difference between the new transperineal biopsy and the traditional transrectal biopsy is that the new approach dramatically reduces the need for antibiotics before the procedure.
Prior to a transrectal biopsy, the patient usually receives a quinolone antibiotic, such as ciprofloxacin. But between 15% and 30% of typical bacteria in the colon are resistant to this powerful antibiotic. The Centers for Disease Control and Prevention estimates that the problem of antibiotic resistance by bacteria will only worsen with time. Bacteria can develop resistance to antibiotics the more they are exposed to them.
Patients who have previously been treated with multiple antibiotics, who work in medical facilities, who travel internationally or who have a weakened immune system are more prone to be resistant to the antibiotics. As a result, they have a higher risk for infection. Patients who fall into those categories are better served by a technique such as the transperineal prostate biopsy that requires little to no antibiotic treatment prior to the procedure. It’s also a better choice for people who have drug allergies or who have developed serious side effects to antibiotics in the past.
Encourage your husband to talk with his healthcare provider about a transperineal biopsy. While the procedure is not widely available at this time, it is offered at Mayo Clinic and some other large academic medical centers. — Julio Gundian Jr., MD, Urology, Mayo Clinic, Jacksonville, Florida