When a 68-year-old man in Norway died of infection after a transrectal biopsy, his daughter urged change. Four years later, that campaign looks to be a success ― but the US has moved slowly to adapt.
In 2018, a 68-year-old Norwegian stonemason named Roar Gulbrandsen died after undergoing a routine transrectal biopsy.
Twenty annual deaths after transrectal biopsy in Norway, which has a population of 5.5 million people, corresponds to 1230 deaths in the United States, Bjerklund Johansen noted."I think the zeroes speak for themselves," said Jeremy Grummet, MD, a urologic surgeon at Monash University, in Melbourne, Australia."These data are all in line with the literature. Transrectal biopsy is untenable and should be stopped.
"Given the increased safety and accuracy reported in the literature, more and more patients are demanding a transperineal biopsy instead of a transrectal biopsy. The American Urological Association guidelines on prostate biopsy are presently being revised and may soon join with the EUA in recommending the transperineal over transrectal approach," he added.
In 2022, the Norwegian Health Directorate ordered urologists in the country to stop performing transrectal biopsies. At Oslo University Hospital, physicians and nurses are now undergoing obligatory training in diagnosing and treating sepsis, according to Bjerklund Johansen. Another advantage of transperineal biopsies that clinicians often miss, Grummet added, is that it does not require"big gun prophylactic antibiotics, as there is for TR biopsy. In fact, many of us are using no antibiotics at all because it is so easy to sterilize the perineal skin."The American Urological Association has not made a push for adoption of transperineal biopsies in the United States. Some American urologists are being retrained in transperineal methods.
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