Clinical Report: Safety of Transperineal Prostate Biopsy Without Antibiotic Prophylaxis

Overview

This retrospective study of 636 patients undergoing transperineal prostate biopsy without antibiotic prophylaxis found a low rate of postinterventional infectious complications. The findings suggest that omitting antibiotics in this setting may be safe and could reduce unnecessary antibiotic use.

Background

Prostate cancer detection often requires biopsy, with approximately one million procedures annually in the EU. The transperineal approach is favored over transrectal due to lower sepsis risk. While antibiotic prophylaxis is standard for transrectal biopsies, its necessity in transperineal biopsies remains unclear. Given concerns about antibiotic resistance, evaluating the safety of omitting prophylaxis is clinically important.

Data Highlights

A total of 636 patients met inclusion criteria and underwent outpatient transperineal prostate biopsy without antibiotic prophylaxis or preinterventional bacteriuria screening. Procedures included systematic and MRI fusion biopsies under local anesthesia, with sedation added for fusion biopsies. Complications and infectious events were retrospectively assessed from medical charts.

Key Findings

• The rate of postinterventional infectious complications was low despite omission of antibiotic prophylaxis.
• No preinterventional urine or blood testing was performed, and no perioperative bacteriuria screening was done.
• Complications were classified and analyzed with respect to patient factors such as diabetes, immunosuppression, and prior prostatitis.
• Statistical analysis showed no significant increase in infection rates related to omission of antibiotics.
• The transperineal approach combined with antiseptic skin preparation and local anesthesia was well tolerated.
• Retrospective design and follow-up limited to clinic records may underestimate outpatient antibiotic prescriptions or complications managed elsewhere.

Clinical Implications

These findings support the safety of omitting antibiotic prophylaxis in transperineal prostate biopsy, potentially reducing antibiotic overuse and resistance. Clinicians may consider this approach in appropriate patients, ensuring strict antiseptic technique and careful patient selection. Further prospective studies could confirm these results and optimize protocols.

Conclusion

Omitting antibiotic prophylaxis in transperineal prostate biopsy appears safe with low infectious complication rates, highlighting an opportunity to reduce unnecessary antibiotic use in prostate cancer diagnostics.

References

1. Basourakos et al. -- Meta-analysis on antibiotic prophylaxis in prostate biopsy
2. Castellani et al. -- Meta-analysis on infection rates with or without antibiotic prophylaxis
3. Hulscher et al. -- Review of antibiotic prescribing and resistance
4. EAU Guidelines -- Recommendation favoring transperineal over transrectal biopsy