Antibiotics-free transperineal biopsy relatively safe

Performing transperineal biopsy without antibiotic prophylaxis appears to be a safe procedure, with a study reporting no sepsis cases occurring among men who underwent the antibiotic-free procedure.

The analysis included 550 patients who underwent the procedure from three different urological centres. Researchers collected the men’s demographic and clinical data by reviewing electronic medical records. They also conducted structured phone interviews to obtain follow-up data including postoperative complications.

The mean age and prostate-specific antigen (PSA) of the population were 68.3 years and 9.8 ng/ml, respectively. The mean number of biopsy cores sampled was 25.4, and 183 patients (33.3 percent) had a history of previous biopsy. The overall cancer detection rate was 64.9 percent, with 259 patients (47.0 percent) diagnosed with clinically significant cancer (defined as International Society of Urological Pathology [ISUP] >2).

Follow-up data on complications could be retrieved for all patients, except for erectile function (63.3 percent). None of the patients experienced sepsis. Overall, 33 (6.0 percent) patients developed any complication besides mild macrohematuria. Forty-six out of 47 (98 percent) complications were grade 2 or lower, according to Clavien–Dindo.

Multivariate regression analyses showed that a higher number of cores was associated with overall complications (odds ratio [OR], 1.08, 95 percent confidence interval [CI] 1.02–1.14; p=0.01) and bleeding complications specifically (OR, 1.28, 95 percent CI, 1.11–1.50; p=0.01). There was no association note for infectious complications (OR, 1.03, 95 percent CI, 0.97–1.10; p=0.67).

There were 14.4 percent of patients who reported erectile function impairment following transperineal biopsy, and 98 percent of them were diagnosed with prostate cancer.

The findings underscore the safety advantage of transperineal biopsy even in the absence of antibiotic prophylaxis and supports the ongoing initiative to abandon transrectal biopsy of the prostate.