When 68-year-old Norwegian stonemason Roar Gulbrandsen died suddenly, his family was told it was due to an arterial embolus. When his daughter Agnes asked if it could be related to the transrectal biopsy of the prostate that her father had received the day before he became ill, the physicians scoffed.
But she was diligent in searching for answers and finally Dr. Bjerklund Johansen, her father’s urologist, revealed what most likely happened: a serious infection or sepsis created an arterial embolism to the brain. Dr. Johansen had become more and more concerned about the link between transrectal biopsy procedures and serious infection. Together, Agnes and Dr. Johansen crusaded to change policy from transrectal to transperineal prostate biopsies.
In transperineal biopsy, the urologist passes the biopsy needle through the skin behind the testicles (perineum) and into the prostate, rather than passing the biopsy needle through a potentially contaminated rectum. Physicians were initially reluctant to adopt this procedure, but a public education campaign was a success — people started demanding the transperineal procedure. In response, the European Urological Association recommended that urologists switch from transrectal biopsies to transperineal biopsies in 2021. Annual deaths in Norway linked to transrectal prostate biopsies fell from about 20 in 2017 to zero in 2021–2022.
Yet currently only 10% of prostate biopsies in the United States use the transperineal method. Why is the U.S. lagging behind? The expense of new equipment and retraining are likely factors, Howard Wolinsky wrote for Medscape in March. The issue was brought up at the American Urological Association meeting in April, 2023 but the outcome was a recommendation for both transrectal and transperineal approaches.
You can help spread the word by sharing this information with others. Patients can demand the safer transperineal prostate biopsy, and the power of the free market can help to change practice — as it did in Norway.
You can also sign this petition to phase out transrectal biopsies for prostate cancer. A few minutes of your time could save someone’s life!
