Part II: The Ugly American (Urologist)?
Vote with your prostate—and feet—and doctors will follow.
By Howard Wolinsky, The Active Surveillor
TheActiveSurveillor.com (that’s me) wrote recently wrote about transperineal biopsies and what it will take to persuade physicians to offer them routinely. I plan to write more.
The migration to transperineal biopsies needs to continue, especially in the U.S.
American urologists, unlike their European and Canadian colleagues, have been slow to adopt the new transperineal procedure.
Why?
The American urologists believe their own patients are safe and unaffected by potentially deadly and disabling sepsis, blood-borne infection. A urologist cousin of mine, who practices in a prominent urology group in the U.S., told me she just knew her patients are not affected by the sepsis issue—even though she hasn’t checked her stats recently. That’s the prevalent attitude: Transrectal ultrasound biopsies ain’t broke, so why fix ‘em?
Urologists seem to downplay the need to limit the use of IV antibiotics, which, if prescribed too often, will lead to an increase in antibiotic-resistant organisms. Urologists find transrectal procedures save a few minutes, adding incrementally to their bottom lines.
Also, the Ugly American (Urologist) is cheaping out on the $40k it costs for retraining and retooling—even though there isn’t a steep learning curve.
Sadly, unbelievably, they are opting for better workflow and efficiency over patient safety. Even one case of sepsis in patients undergoing biopsies these days is unforgivable, unacceptable.
There’s another safety issue. I have a friend who had several transrectals and had an all-clear for active surveillance. Three years in, he had a transperineal biopsy and micro-ultrasound. Doctors found he had Gleason 9 cancer—which a typical transrectal biopsy missed.
To get an overview on this issue, read my article in MedPage: “No More Men Need to die from Transperineal Biopsies”: https://www.medpagetoday.com/special-reports/apatientsjourney/92201
Or check out my call for retiring transrectal biopsies in MIT’s Undark Magazine, Opinion: A Common Biopsy Is Putting Lives at Risk. It’s Time to Retire It. Many physicians are abandoning the transrectal biopsy due to its risks of deadly infection. Others should follow suit: https://undark.org/2021/07/29/common-biopsy-is-putting-lives-at-risk/
Read the tale of my friend Ferd Becker, MD, a facial plastic surgeon from NOLA, who nearly died from a transrectal biopsy: https://www.medpagetoday.com/special-reports/apatientsjourney/74624
This is a serious business, and it is beyond the time when urologists took it seriously.
What can you do?
Be an TheActiveSurveillor.com Super-Activist and sign my petition to phase out the transperineal biopsy at change.org: https://chng.it/7bQsWSfK
(The 1,000th person to sign gets a free copy of my new book “Contain & Eliminate” about a conspiracy by the American Medical Association to destroy alternative medicine. Sometimes conspiracies are for real.)
Is there any sign of hope on the TP front?
Yes. Australian urologists have migrated in droves to TP. Medicare, their national health plan, pays a bonus to docs who opt for TP over transrectal biopsies. The American Urological Association just sent a survey to Aussie urologists to ask about the changeover.
Could something be in the works at the ever-mysterious Land of AUA? Stay tuned. You never know.
Many patients troubled about the potential for sepsis and the risk of missing pockets of prostate cancer are ready for the change.
In any case, The Active Surveillor knows from a survey we took last spring that educated patients often go for TP. Active Surveillance Patients International and AnCan Virtual Support/AS members, who took the survey, are more likely than men, in general, to opt for transperineal over transrectal biopsies. It’s the smart and safe way to go—to avoid sepsis and to detect hidden high-grade prostate cancers,
Our survey last year of 165 men showed that 17% of us opt for TP vs. a 5% average nationally.
Numbers may be growing. An ongoing survey shows that nearly 25% of The Active Surveillor audience is getting on the transperineal train—though it is difficult to find a sympathetic doctor in many parts of the country. I know patients who have traveled hundreds, even a thousand miles to get a TP.
Please take TheActiveSurveillor’s Quick Survey on transperineal v. transrectal biopsies and sound off https://www.surveymonkey.com/r/D2J8XY9
(In a future newsletter, I’ll cover the emerging debate over TPs done in the OR v. the office.)
What else can you do?
As Dr. Danny Vesprini, a radiation oncologist at the University of Toronto and an AS advocate, advised last week in the webinar mentioned above, doctoring is a business like any other. Share your position with your doctor. If you’re unhappy with his/her response, find a urologist, radiation oncologist, or radiologist (it varies from country to country) who will support you.
It may not be easy. But keep pushing.
Patients in Norway and Australia have done this. American patients can, too.
Vote with your prostate—and feet—and watch the doctors follow.
Just the fact that transperineal gives better access to areas of the prostate during biopsies should be enough to convince doctors of the benefit. And of course, the risk of avoiding sepsis goes without saying...although you ARE saying it. Good work!!