njms people High-Tech Prostate Biopsy:
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Greater Accuracy, Less Infection BY AMANDA CASTLEMAN
KEITH B. BRATCHER, JR.
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rostate cancer has been on the rise since 1975, and men now face a one in five chance of a diagnosis. Fortunately, mortality has declined by 30 percent in that period, thanks to more effective screening and treatment. Now that forecast could get even brighter, as NJMS has launched a high-tech new program under the oversight of urologic oncologist Evan Kovac, MD, associate professor of urology in the Department of Surgery. The first prostate biopsy occurred in 1926 via an incision in the perineum, the area that marks the lower boundary of the pelvis. This evolved into samples taken with 18-gauge needles, which had an 88 percent accuracy rate. But in the 1950s, doctors instead began approaching via the rectum, which provided better access to the area most implicated in cancer, the prostate’s peripheral zone. “Transrectal prostate biopsy is a very effective diagnostic technique,” says Kovac. “But it’s fraught with dangers, because you’re directing a needle through the rectal wall, which is full of bacteria and stool, carrying a significant infection risk [between one to five percent, depending on the study].” This transrectal technique typically requires not just one, but two, prophylactic antibiotics to prevent infection—and even then, some risk remains. “It’s not good stewardship,” Kovac points out. “Bacteria are becoming increasingly resistant, and we’re not developing any new antibiotics. Accordingly, there is a shift to other diagnostic techniques. “Britain has Brexit and we have Trexit, an exit from transrectal biopsy,” he adds with a smile. Instead, doctors like Kovac have returned to the perineum: a process known as transperineal prostate biopsy. “For most patients, antibiotics aren’t necessary, and the infection risk is very low [0.9 percent] … comparable to the transrectal approach with two antibiotics,” says the physician. He’s found the patient experience to be superior too. “They’re experiencing fewer side effects, such as less blood in the urine and reduced post-procedural pain. “I believe we’re the only center performing this type of prostate biopsy in northern New Jersey,” Kovac says. “And we’ve got one