Breaking news: Transperineal biopsies beat transrectals in AnCan debate

By Howard Wolinsky

Transperineal biopsies were the audience’s choice by a wide margin over transrectal biopsies in a debate by experts at the Monday night debate at AnCan as the American Urological Association prepares to make recommendations on the topic in 2023.

Arvin George, MD, a urologist at the University of Michigan, took the pro-transperineal side.

Deborah Kaye, MD, a urologist at Duke University, took up the transrectal side.

Both doctors did an excellent job defending their positions. I will report details soon from the debate. [Meanwhile, you can read this: https://www.medpagetoday.com/special-reports/apatientsjourney/92201]

Take note: Only 5% of the 2 million American men who undergo prostate biopsies annually have opted for transperineal biopsies, which are reported to be safer because they avoid the germy rectum and yield similar results to transrectal biopsies.

The audience of nearly 150 at the debate was unsual: 16% had undergone transperineal biopsies—about three times the national average. Transrectal biopsies are more common as transperineal biopsies are not yet widely available.

After the debate, and again after cross-examinations and audience questions as we were closing, we took audience polls and received similar results.

Transperineal biopsies won the day. Forty-eight percent of respondents said their next biopsy would be a transperineal; 22% said they would opt for transrectal biopsies, and 30% had no preference or were unsure.

This same debate will go on behind closed doors at the American Urological Association in 2023. The AUA guidelines group is actually gearing up already.

I hope AUA will consider our results for a patient POV. The AUA panel should also consider the fact that the European Association of Urologists last year made transperineal biopsies its #1 choice mainly on safety concerns and to control problems with antibiotic-resistant organisms.

I can’t predict what the AUA outcome will be. Big money and politics are at play. Many urologists will resist change because they believe the status quo is acceptable.

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Active Surveillance 101 course launches at ASPI meeting

ASPI will be premiering the first of a new video series named "Active Surveillance 101" at noon Eastern on September 24, 2022.

Like 101-level courses in colleges, AS 101 is aimed at teaching the basics. In this case, it's the basics of active surveillance, close monitoring of low- to favorable intermediate-risk prostate cancer.

The program features conversations between actual patients and their partners/spouses and leading experts. The goal of this series is to reach all AS candidates, including those who have not yet been diagnosed with prostate cancer but have rising PSAs (prostate-specific antigen) blood levels and offer them an introduction to AS and help them formulate questions when they go to their family doctors, urologists, or oncologists.

Register here: ASPI SEPTEMBER ZOOM MEETING

The first episode features a couple , Nancy and Larry White in a simulated office visit with Dr. Steve Spann, a top family physician and dean of the University of Houston College of Medicine. They discuss Larry's rising PSA and what it may mean.

In subsequent episodes, the couple visits Dr. Laurence Klotz, of the University of Toronto, the "father of active surveillance." Other episodes of AS 101 are being developed on biopsies, imaging, and DNA testing.

AS 101 is sponsored by the Active Surveillance Coalition, which includes Active Surveillance Patients International, the AnCan Virtual Support Group for Active Surveillance, Prostate Cancer Support Canada, Prostate Cancer Research Institute, and TheActiveSurveillor.com newsletter. We encourage you to share this series with anyone who you know who is dealing with this issue, including your family physician.

View the ASPI session on genetics

Men and their families can learn valuable facts from a cancer genetic test. While the use of genetics testing for cancers is still growing, the existing state of the art for prostate and related cancers is a powerful tool for identifying men and persons at risk. This 60-minute expert presentation features Robert Finch, MS, a certified genetic counselor, of Myriad Genetics,  and medical oncologist Michael Glode, MD. The video is available at https://aspatients.org/meeting/