By Howard Wolinsky Last April, I thought that by this point in 2024, the American Urological Association (AUA) might have been on the verge of endorsing transperineal (TP) biopsies as a safe choice to replace germy transrectal (TR) biopsies with its rare but real risks for deadly and disabling sepsis.
#1 reason TP is lagging in the U.S. is that people (in this case, doctors) don't like change. #2 $$$ as detailed in the article. #3 Would require training of 1000s of Urologists. And sadly, most U.S. physicians don't care about antibiotic stewardship. I review charts as part of my job and most antibiotics are prescribed inappropriately in an outpatient setting.
Seems to me the antibiotics stewardship issue should be front and center, not buried in the discussion. Do the studies that compare TR favorably with TP do so only because of prophylactic antibiotics? Are biopsies killing not just the people being biopsied? One leading urologist told me he was proud of his TR safety record. Are American urologists proud of the squandering of antibiotics? This is a genuine "moral hazard" issue. – Peter Swenson
Thanks, Keith.
You're right about resistance to change. "i've mentioned that in previous stories,
And thanks forthe point about antibiotics.
Howard
John,
Can you shrewhat happened in 2008.
Hope you're OK.
HW
#1 reason TP is lagging in the U.S. is that people (in this case, doctors) don't like change. #2 $$$ as detailed in the article. #3 Would require training of 1000s of Urologists. And sadly, most U.S. physicians don't care about antibiotic stewardship. I review charts as part of my job and most antibiotics are prescribed inappropriately in an outpatient setting.
TR at WashU/Barnes, 2008. Sepsis. Almost died. Never again.
Who says prostate cancer isn't funny. Just think of the digital rectal exam ...
And now what's funny about, sepsis, antibiotics and "superbugs"?
Not much. Just look hard enough and a prostate cancer patient will find an angle.
An anonymous Gleason 6 jokester, a winner of the Glee in Gleason Score prostate humor contest, submitted this bit of infectious levity:
"Did you hear the one about the AS patient who was given antibiotic pills before his TR? Didn’t work, they kept falling out!"
HW
(Translations available for the uninitiated for TR and AS.)
Just as I thought. RCT?! Like comparing apples and oranges, or should I say pumpkins and toasters.
Seems to me the antibiotics stewardship issue should be front and center, not buried in the discussion. Do the studies that compare TR favorably with TP do so only because of prophylactic antibiotics? Are biopsies killing not just the people being biopsied? One leading urologist told me he was proud of his TR safety record. Are American urologists proud of the squandering of antibiotics? This is a genuine "moral hazard" issue. – Peter Swenson