AUTHOR REPLY

These comments are all very apt and important. Fortunately, in our described series of transrectal ultrasound (TR) biopsy, we had no serious infection cases, but sepsis, and or significant rectal bleeding remain potential risks of TR biopsy. The increasing frequency of adverse events have been important factors in the recommendations of various guideline panels in advising against Prostate-Specific Antigen (PSA) screening and early prostate cancer detection. With new PSA-based biomarkers and MRI, there have been tremendous improvements in our ability to identify the appropriate men for biopsy who have a high likelihood of finding clinically meaningful cancer, while avoiding invasive procedures on many with abnormal PSA from benign causes. The ability with TP biopsy to avoid both severe sepsis and rectal injury are important features of this approach. The impracticality of widespread adoption of this technique was that prior techniques required general anesthesia. We describe our early experience, with a significant learning curve, of adopting TP biopsy to an office setting. There certainly were lessons learned. The time to complete the procedure was not formally measured but has improved to be competitive with TR biopsy. The described complications have not carried through with our mature experience. There are very important questions to be answered among them: Should any antibiotic prophylaxis be used? What is the optimal template and how to translate this to the extensive body of experience with TR template? How do we recoup the additional cost of disposables? We firmly believe that this must be the future of prostate cancer diagnosis as it is so much safer for the patients and it offers a better sampling of the peripheral zone and anterior prostate. We described our experience with the hope this will ease adoption by others.