Men undergoing prostate biopsy for prostate cancer diagnosis or active surveillance
Care Setting
Hospital outpatient or inpatient urology clinics performing transrectal prostate biopsies
Key Highlights
Infection rates after transrectal prostate biopsy range from 0.1% to 7.0%, with sepsis rates 0.3% to 3%.
MRI-targeted biopsy (MRI-TB) uses fewer cores (average 3.7) compared to systematic biopsy (SB) with 12 cores, resulting in fewer infectious complications.
No significant difference in blood culture positive sepsis between MRI-TB and SB, but other infection markers and symptoms are significantly lower after MRI-TB.
Guideline-Based Recommendations
Diagnosis
Use MRI and MRI-targeted biopsy to improve prostate cancer detection compared to systematic biopsy.
Management
Administer antibiotic prophylaxis prior to biopsy; ciprofloxacin 750 mg orally 1 hour before biopsy is standard.
Use fosfomycin trometamol instead of ciprofloxacin if patient has recent travel history abroad within 3 months.
Monitoring & Follow-up
Monitor for infectious complications within 30 days post-biopsy using urine cultures, blood cultures, urine leukocyte counts, and C-reactive protein (CRP) levels.
Increased testing frequency (urine cultures, CRP) may reflect higher suspicion of infection, especially after systematic biopsy.
Risks
Transrectal biopsy carries risk of infection due to needle passage through bowel wall.
Higher number of biopsy cores (as in systematic biopsy) is associated with increased bleeding and pain; infection risk may also be higher.
Antibiotic overuse has led to fluoroquinolone-resistant Escherichia coli as the most common pathogen post-biopsy.
Patient & Prescribing Data
Patients undergoing transrectal prostate biopsy for prostate cancer diagnosis or surveillance.
Antibiotic prophylaxis reduces infection risk but resistance is increasing; MRI-targeted biopsy reduces infectious complications likely due to fewer cores taken.
Clinical Best Practices
Prefer MRI-targeted biopsy over systematic biopsy when feasible to reduce infectious complications.
Use appropriate antibiotic prophylaxis tailored to patient travel history to minimize resistant infections.
Closely monitor patients post-biopsy for signs of infection using urine and blood cultures and inflammatory markers.
Educate patients about infection symptoms and ensure prompt evaluation if symptoms develop post-biopsy.
