In the PREVENT trial, reported as a research letter in JAMA Oncology, Hu et al found that transperineal prostate biopsy resulted in less risk of infection than transrectal biopsy in patients with suspicion of prostate cancer, with no difference between methods observed in detecting high-grade prostate cancer.
Study Details
In the U.S. multicenter trial, 875 patients were randomly assigned between February 2021 and March 2024 to receive transperineal biopsy without antibiotic prophylaxis (n = 372) or transrectal biopsy with targeted prophylaxis, rectal culture screening for fluoroquinolone-resistant bacteria, and antibiotic targeting (n = 370). The primary outcome measure was infection after biopsy.
Key Findings
Infections after biopsy were observed in none of the patients in the transperineal biopsy group vs grade ≥ 2 infections in 6 (1.6%) of the transrectal biopsy group (difference = −1.6%, 95% confidence interval [CI] = −3.5% to −0.3%, P = .02).
With regard to other complications, urinary retention occurred in 1 (0.3%) vs 4 (1.1%) patients (difference = −0.8%, 95% CI = −2.5% to 0.6%, P = .20) and bleeding occurred in 0 vs 1 (0.3%) patient (difference = −0.3%, 95% CI = −1.5% to 0.8%, P = .50).
High-grade cancer (Gleason grade 2–5) was detected in 55% of patients in the transperineal group vs 52% in the transrectal group (difference = 2.9%, 95% CI = −4.1% to 9.8%, P = .40).
The investigators concluded: “Transperineal biopsy had similar cancer detection rates as transrectal biopsy, but there were no infections after transperineal biopsy.”
Jim C. Hu, MD, MPH, of Weill Cornell Medicine New York Presbyterian, is the corresponding author for the JAMA Oncology article.
Disclosure: The trial was supported by the National Cancer Institute. For full disclosures of all study authors, visit JAMANetwork.com.
