Infectious Risks After Transrectal MRI-Guided vs Systematic Prostate Biopsy
Overview
This study compared infectious complications within 30 days following transrectal systematic biopsy (SB) and MRI-targeted biopsy (MRI-TB) of the prostate. While blood culture positive infections were equally rare in both groups, other infection indicators such as positive urine cultures, elevated leukocytes, and CRP levels were significantly more common after SB than MRI-TB.
Background
Prostate biopsy is essential for diagnosing and monitoring prostate cancer but carries risks including bleeding and infections. Transrectal biopsy is widely used but associated with infection rates ranging from 0.1 to 7.0%, with increasing hospitalizations due to infections globally. MRI-targeted biopsy improves cancer detection and typically requires fewer biopsy cores than systematic biopsy, potentially impacting infection risk. Antibiotic prophylaxis is standard but challenged by rising antibiotic resistance, particularly fluoroquinolone-resistant E. coli.
Data Highlights
Infection Parameter
Systematic Biopsy (SB)
MRI-Targeted Biopsy (MRI-TB)
p-value
Blood Culture Positive Infections
23 (0.9%)
23 (1.0%)
0.848
Positive Urine Cultures
77 (2.7%)
42 (1.7%)
0.022
Urine Leukocytes ≥ 100 E6/L
111 (3.9%)
61 (2.5%)
0.006
CRP ≥ 100 mg/L
122 (4.2%)
72 (3.0%)
0.015
CRP Tests Taken
More frequent
Less frequent
Significant
Urine Cultures Taken
More frequent
Less frequent
Significant
Blood Cultures Taken
More frequent
Less frequent
Not significant
Key Findings
Blood culture positive infections were rare and occurred at similar rates after SB (0.9%) and MRI-TB (1.0%).
Positive urine cultures were significantly more common after SB (2.7%) compared to MRI-TB (1.7%).
Elevated urine leukocytes (≥ 100 E6/L) were more frequent after SB (3.9%) than MRI-TB (2.5%).
Elevated CRP levels (≥ 100 mg/L) occurred more often after SB (4.2%) than MRI-TB (3.0%).
Tests indicating suspicion of infection (CRP and urine cultures) were performed more frequently after SB than MRI-TB.
The lower number of biopsy cores in MRI-TB (average 3.7) versus SB (12 cores) may contribute to the reduced infection markers observed.
Clinical Implications
MRI-targeted biopsy, requiring fewer cores, is associated with fewer infectious complications markers compared to systematic biopsy, suggesting a safer infection profile. Although severe bacteremic infections were equally rare in both methods, clinicians should consider MRI-TB as a preferable option to reduce infection risk. Continued vigilance and appropriate antibiotic prophylaxis remain essential given rising antibiotic resistance.
Conclusion
Infectious complications after transrectal prostate biopsy are generally low, but MRI-targeted biopsy is associated with significantly fewer infection indicators than systematic biopsy. These findings support the use of MRI-TB to potentially reduce infectious morbidity in prostate cancer diagnosis.
References
Systematic review on bleeding complications [1]
Infection rates after transrectal biopsy [2, 3]
Rising hospitalization rates due to infections [4, 5]
Transperineal biopsy reduces infections [6]
Antibiotic resistance and fluoroquinolone-resistant E. coli [7, 8, 9]
MRI and MRI-targeted biopsy improve PC detection [10, 11]
Randomized trial comparing transrectal and transperineal biopsies [12]
Bleeding and pain related to biopsy cores [13, 14]
