Current practice of prostate biopsy in Australia and New Zealand: A survey

Introduction: Prostate biopsy remains the gold standard for prostate cancer diagnosis. The field of prostate biopsy is undergoing a rapid change. This study aims to provide a snapshot of the current practice of prostate biopsy in the Urological Society of Australia and New Zealand (USANZ). Materials and Methods: A 31-question multiple-choice survey was constructed using a web-based provider and was distributed to 644 members of USANZ. The questionnaire addressed various aspects of prostate biopsy. Questionnaire results were collated and the data were analyzed statistically. Results: 150 completed surveys were returned, with a response rate of 23.3%: 84.5% of those completing the survey were consultant urologists and 68% were working in a metropolitan setting. 98.6% of clinicians used prophylactic antibiotics before prostate biopsy, most commonly a quinolone. 30.6% had used intravenous (IV) carbapenems at least once. Peri-prostatic local anesthetic (LA) infiltration was used by 39.9% of clinicians with 73% using IV sedation or general anesthetic (GA). 38.4% of clinicians reported performing TPT biopsy of the prostate and 19.6% of clinicians had ordered a MRI of the prostate prior to an initial biopsy with 10.2% routinely ordering a MRI of the prostate before repeat biopsy. Conclusion: Frequent prophylactic use of carbapenems suggests concern amongst clinicians about sepsis with quinolone-resistant bacteria. Almost 75% of TRUS biopsies were performed under IV sedation or GA indicating a heavy demand of health resources. TPT biopsy was used commonly and there was significant use of multiparametric MRI prior to prostate biopsy.