A Safer, More Precise Prostate Biopsy

After nearly two years of using a biopsy method known as the transperineal approach, UConn Health urologists report higher-quality prostate samples and zero infections.

Ultrasound-guided prostate biopsy in operating room

Dr. Ben Ristau performs a transperineal prostate biospsy in the UConn Health Surgery Center. UConn Health is among a relative few American health care institutions that take this approach to prostate biopsies, which has been shown to be safer and more precise. (Photo by Kristin Wallace)

It’s one of those subjects men might find uncomfortable discussing and might not want to spend time thinking about, but how a prostate biopsy is taken can make a big difference.

Albertsen Deemed ‘World Expert’

Dr. Peter Albertsen, chief of UConn Health’s Division of Urology, has been recognized as a “World Expert” in prostate cancer by Expertscape, an international online database of medical experts. The site uses an algorithm based on the number and frequency of physicians’ published scientific articles, and determines Albertsen to be in the top 0.013% of more than 155,000 published authors worldwide in the category of “prostatic neoplasms” over the last 10 years. (Photo by Tina Encarnacion)

Traditionally, a urologist or ultrasonography technician would take a tissue sample of the prostate through the rectum, known as a transrectal biopsy. At UConn Health, biopsies are done exclusively by urologists who use what’s known as a transperineal approach. Rather than piercing through the contaminated rectal wall, they access the prostate through sterilized skin behind the scrotum.

When Drs. Peter Albertsen and Ben Ristau started doing transperineal biopsies in early 2019, they suspected this approach would greatly reduce the risk of an infection that can lead to hospitalization for sepsis, which generally occurs in up to 4% of men who undergo a transrectal biopsy.

Now, nearly 200 procedures in, “We still have not had our first infection, and we’ve used no antibiotics,” says Albertsen, UConn Health’s chief urologist.

Transperineal biopsy is becoming more commonplace in Europe and is the standard of care in Australian hospitals, but it’s yet to take hold widely in the U.S. UConn Health is one of a small number of locations in the Northeast that offers it. And as patients become more educated about this approach, they’re willing to travel to have it done.

One such patient is Stephen, 63, who lives in southern New Hampshire. He is an educated professional who did his research on what would be his first prostate biopsy, and he did not like what he was reading about the transrectal approach. So he started looking for places that offered the transperineal approach.

“There’s no one in New Hampshire, or northern Massachusetts,” Stephen says. “I did find someone in Boston who did it, but he told me he rations that procedure and I don’t qualify.”

‘I was going to have the best, lowest-risk biopsy I could get. And that’s what I got.’

—Stephen, 63, New Hampshire

He was making plans to travel to Philadelphia to have it done.

“Then my wife discovered Dr. Albertsen and UConn Health,” he says. “I read an article in the UConn newsletter about how he does transperineal prostate biopsies, and thought, ‘This is what I want. We’re going here.'”

“I read up on Dr. Albertsen and thought, ‘We’ve hit a home run here, let’s go.’”

Ten days after his initial consultation, Stephen returned to have the biopsy done at UConn Health, which is a two-and-a-half-hour drive from his home.

“The nurses were great, the anesthesiologist was great,” he recalls. “I woke up with no pain and got dressed. I had only minor soreness, which was hardly noticeable.”

That was on a Friday. His wife drove him home that afternoon and the following morning he was taking his regular three-mile morning walk.

“I went back to work that Monday, and by Tuesday there was no soreness at all,” Stephen says.

The sepsis-free streak aside, Albertsen and Ristau have observed other benefits to this new approach to prostate biopsy.

Dr. Ben Ristau portrait white coat
Dr. Ben Ristau is UConn Health’s surgical director of urologic oncology. (Photo by Tina Encarnacion)

“I think one of the things I have come to appreciate is how much of a better job we are doing sampling the prostate,” Albertsen says. “We can much more precisely sample areas in the apical region of the prostate than we could using the transrectal probe.”

“I completely agree, I would never go back to transrectal,” says Ristau, UConn Health’s surgical director of urologic oncology. “Through the transrectal approach, it was routine to give preventive antibiotics in order to reduce the risk of infection. The problem with antibiotic overuse is that it has the potential of creating ‘superbugs,’ essentially antibiotic-resistant bacteria. Using the transperineal approach, we’ve omitted antibiotics entirely because we don’t have to go through the contaminated rectum to do the biopsy. We can simply sterilize the skin.”

Patients go under sedation for the biopsy, similar to how they would for a colonoscopy. The procedure lasts about a half-hour, and patients go home the same day.

As for Stephen, his biggest concerns never came to be.

“I think the world of Dr. Albertsen,” he says. “I avoided the tremendous risk that the transrectal biopsy posed – all of these risks that a lot of urologists are not up front about.”

“I was going to have the best, lowest-risk biopsy I could get. And that’s what I got.”

September is Prostate Cancer Awareness Month. Learn more about the UConn Health Division of Urology.