Transperineal biopsies on rise, TheActiveSurveillor.com survey
Our international colleagues who are on AS or are AS curious
(Editor’s note: A new reader from Cuba has joined the ranks of nearly 2,000 readers of TheActiveSurveillor.com Bienvenido, amigo. We prostate cancer patients come from everywhere. Most readers of this newsletter come from the United States (81%) and Canada (5%). But readers come from a wide range of countries around the world, more than 60 all told. .2% each of readers come from U.K. and Australia.
(Some came as surprises to me. For example, readers from Morocco make up 1% of the readership. Go Mo.
(I had no idea I had followers in Middle Eastern or African countries, including Egypt, Iraq, Nigeria, Ethiopia, and South Africa; Asia from India, Pakistan, Thailand, Taiwan, Japan, Philippines, Indonesia and Malaysia; Latin Americans from Argentina, Brazil, Colombia, Ecuador, Honduras, and Mexico. Europeans from Russia, Poland, Iceland, Norway, Sweden, Denmark, France, Spain, Italy, Netherlands, Ireland, Germany, Estonia, Slovakia, Austria, Switzerland, Romania, Hungary, Czech Republic. Australia and New Zealand are included. I suspect some are from Antartica
(Welcome, all. Next time, I’ll share U.S. demographics.)
By Howard Wolinsky
A new TheActiveSurveillor.com survey shows that transperineal biopsies are making gains at least among this Substack’s readers.
Most of you by a wide margin (in small sample) would opt for transperineal biopsies through the taint to avoid risk of deadly and disabling sepsis.
(Let’s hear your opinion on issues confronting those of us on AS: Please answer the questionnaire here: https://forms.gle/ff2SGLT8285ngyMF9)
In the U.S., where transperineal biopsies are consider the equal to transrectal propstate biopsies, gains are being made, according to preliminary results from a patient survey.
The national rate for transperineal (TP) biopsies in the U.S is roughly 10%, up from 5% two years ago, according to urologist Matthew Allaway, DO, founder of Perineologic, developer of an updated, less-invasive system of transperineal known as PrecisionPoint. Doubling sounds like a big deal. But the numbers are so small.
TP rates among the well-informed readers of TheActiveSurveillor.com are a far different story. At this point, 14.3% in the survey said they only had transperineal, and 30.6% have had both TP and TR over time. Likely, the most recent biopsies have been TP as this revolution in care unfolds.
53% of us only have had only transrectal biopsies.
Norwegian researcher Truls Bjerklund Johansen has estimated, based on his figures from Norway, that about 2,000 American patients a year die from transrectal biopsies.
(Read about the Norwegian experience: https://www.medscape.com/viewarticle/989696 and that in Australia at https://howardwolinsky.medium.com/the-movement-to-make-transrectal-biopsies-go-extinct-e6e16538769f Also, check out “No More Men Need to Die from Transrectal Biopsies” https://www.medpagetoday.com/special-reports/apatientsjourney/92201
2,000 deaths out of 2 million prostate biopsies each year in the U.S. Some urologists would just sniff that the numbers are small. I know many urologists simply don’t believe them. But if you’re one of the 2,000, that’s 100% for you and your family.
Bjerklund Johansen, prodded by the daughter of one of patients who died from a prostate biopsy, started pushing for a change in guidelines at the European Association of Urologists. In 2021, EAU adopted a guideline designating transperineal biopsies—going through the taint—as the preferred biopsy.
The American Urological Association has moved a bit on the issue. In 2023, they designated transperineal biopsies as equal to the more common transrectal biopsies. Change comes slowly in medicine,
AUA has said research will be needed to upgrade TP’s standing. In September, Dr. Jim C. Hu, a urologist at Weill Cornell Medicine/NewYork-Presbyterian Hospital, published a long-awaited multi-center study showing that TP reduce the incidence of sepsis. An earlier single-center study showed the opposite.
As I put it my article in Medscape Thursday: TP and TR “are in a dead heat for diagnosing prostate cancer, but none of the participants who received TP developed infections [in the Hu study] while 1.6% of the TR group did.”
Hu said additional research likely will be needed to win over the AUA. An AUA spokesperson said the organization’s early-detection guidelines will be reviewed in 2025.
Meanwhile, a growing number of American men are voting with their prostates and feet, switching to transperineal biopsies.
Almost 2/3rds of survey respondents (65.3%) say that if they need a biopsy, they are going transperineal while 14.3% would pick a transrectal biopsy and 20.4% have no preference. The pro-TP voice in these respondents is loud and clear.
Sign my petition to phase out the transrectal biopsy at change.org: https://chng.it/7bQsWSfK
Clock running out to register for webinar on ‘Active Surveillance ‘2025’
By Howard Wolinsky
Paid subscribers and founding members get a free pass to “AS25,” a special program this newsletter is hosting noon-1:30 p.m., Saturday ,Jan. 4, 2025.
If you want to join us, get a paid subscription here:
This is the first such program TheActiveSurveillor.com has hosted. I am providing a premium to paid subscribers and trying to keep this newsletter afloat. (That’s my public TV/radio-style appeal for your help.)
If you can’t afford it, or have special circumstances (such as living in a country facing a banking boycott from the U.S. or are a working musician), let me know and we’ll work it out. One donor has created a fund to cover these subscriptions.
.Sorry, the newsletter may seem free, but I devote considerable time to producing the newsletter two or three times a week, turning down more lucrative work.
I will report on any news coming out of the webinar.
One bit of the news. Famed uropathologist Jonathan Epstein, MD, is making his first appearance at a patient meeting in almost two years. He had kept a low-profile since resigning from Johns Hopkins in February 2024 following a dispute with Hopkins, his professional home for almost 40 years.
Dr. Epstein will be speaking on a panel on what happened in prostate cancer in 2024 and what’s on tap for 2025.
Previously announced panelists are:
—Brian Helfand, MD, PhD, chief of urology at NorthShore University HealthSystem outside Chicago, an expert not only in prostate cancer but also in molecular biology.
—Christian Pavlovich, MD, who runs the Active Surveillance program at Johns Hopkins and recently co-authored a major study on diet.
—Timothy Showalter, MD, MPH, medical director of Artera AI, which has made news with its prostate test to help patients decide whether to go on AS.