What the Evidence Says About Prostate Biopsies: Safety, Accuracy, & Cost

Описание: The debate continues — but the evidence is changing. Three lead investigators from PROBE-PC, PREVENT, and TRANSLATE explain what today’s data really shows about infection risk, cancer detection, comfort, and Active Surveillance decision-making.

Are transperineal biopsies truly safer and more accurate — or is the long-used transrectal approach still a valid option?

In this expert roundtable hosted by Active Surveillance Patients International (ASPI), three leading investigators behind the major randomized trials of the past two years share what the newest evidence really tells us. Together, they compare infection risk, cancer detection, patient comfort, and cost — helping men on Active Surveillance understand how biopsy techniques are evolving and what questions to ask their doctors.

SPEAKERS:
🔹 Dr. Badar Mian, University of Albany — Lead investigator of the PROBE-PC trial, finding comparable cancer detection and very low infection rates for both approaches.
🔹 Dr. Jim Hu, Weill Cornell Medicine — PI of the PREVENT trial, reporting zero infections with transperineal biopsy using modern freehand techniques.
🔹 Dr. Alastair Lamb, Oxford University — Co-lead of the TRANSLATE trial, showing a 5–6% improvement in clinically significant cancer detection with the transperineal approach, even without routine antibiotics.

The panel explains how we got here, why earlier assumptions about infection risk are being challenged, and why technique, experience, and imaging quality often matter as much as the route itself. They also explore what this means for men undergoing repeated biopsies on Active Surveillance, and how guidelines may shift as more data emerge.

KEY POINTS
✅ Both biopsy routes show very low rates of serious infection in experienced hands.
✅ Transperineal biopsy can often be done with little or no antibiotics, supporting antibiotic stewardship.
✅ MRI-targeted techniques improve accuracy regardless of route.
✅ Cancer detection is similar, though some trials show a modest advantage for transperineal.
✅ Pain and short-term urinary symptoms may be higher with transperineal — but usually resolve quickly.
✅ For many patients, the skill and experience of the clinician matter more than the biopsy route.

CHAPTERS
00:00 – Welcome, ASPI overview, meeting format, disclaimers
03:11 – Why this discussion matters for Active Surveillance
05:57 – Background: Overview of biopsy approaches, guidelines, sepsis concerns & new evidence
09:57 – PROBE-PC trial: design and safety outcomes (Dr. Mian)
18:03 – PROBE-PC: infection rates, detection, pain & cost (Dr. Mian)
24:56 – PREVENT trial: zero infections & modern freehand TP technique (Dr. Hu)
33:05 – PREVENT: infection breakdown, contamination, and outcomes (Dr. Hu)
35:59 – TRANSLATE trial: UK context & randomized design (Dr. Lamb)
46:02 – TRANSLATE: detection advantage & antibiotic-free TP biopsy (Dr. Lamb)
53:05 – Comparing the trials: strengths, limitations & common findings
58:01 – Expert reflections: what patients should take away
1:00:56 – Extended Q&A: MRI quality, confirmatory biopsies, PSA density, targeting, guideline changes

ABOUT ACTIVE SURVEILLANCE PATIENTS INTERNATIONAL (ASPI)
Active Surveillance Patients International (ASPI) is a nonprofit led by and for men with prostate cancer who believe that knowledge is power and that careful monitoring can be a smart, safe choice.

We educate, connect, and empower men choosing Active Surveillance — helping them minimize overtreatment, understand their risks, and make informed decisions with their medical team.

Through webinars, patient stories, resources, and global outreach, ASPI is shifting the conversation: we’re not anti-treatment — we’re pro-informed choice.

Learn more and explore resources for men and families at:
🔹 https://aspatients.org

SUPPORT ASPI
Your support helps men worldwide find clarity and peace of mind after a prostate cancer diagnosis.

Every donation strengthens our mission — funding educational webinars, community programming, and advocacy for smarter, less invasive care. Together, we’re proving that Active Surveillance is not inaction — it’s a thoughtful, evidence-based path.

Help us keep these programs free and accessible to all:
🔹 Donate today: https://aspatients.org/donate