Do Transperineal Prostate biopsy require Antibiotic prophylaxis?

According to a recent retrospective research presented by Andreas and team at the Society of Urologic Oncology's 22nd annual conference, transperineal biopsies may be done in an office under local anesthetic with minimal risks of infection problems even in patients who do not get prophylactic antibiotics.

Post-biopsy problems are more prevalent in patients with bigger prostates and longer operation timeframes. Although studies have shown that transperineal biopsy can assist reduce the prevalence of post-biopsy urinary tract infections (UTIs) and sepsis, there is no agreement on the use of antibiotic prophylaxis for transperineal biopsy. At a single institution, a team of researchers investigated the hazards of transperineal biopsy in relation to antibiotic use.

The study comprised 372 individuals who had 12-core transperineal biopsies between November 2017 and September 2020. (298 in the office under local anesthesia and 67 in an operating room under general anesthesia). The men's average age was 64 years (range 41-87 years). The use of pre-procedure antibiotics was at the discretion of the surgeon. Prophylactic antibiotics were given to 51 individuals (14%).

The key findings of this study were:

1. According to this study, the total risk of infection sequelae following transperineal biopsy without antibiotic prophylaxis was 0.8%.

2. Infectious problems necessitating hospitalization for IV antibiotics were for 0.5% of all cases.

3. Complications occurred in 40 patients (10.8%): 29 (9.7%) of 298 patients in the in-office group and 11 (16.4%) of 67 patients in the operating room group.

4. In all, 6 individuals (1.6%) had urine retention, while 24 had mild hematuria (6.5%). Infectious problems occurred in three individuals (0.8%), with two requiring intravenous antibiotics.

5. Patients with prostate volumes more than 50 grams had considerably higher rates of problems than those with lower volumes (18.7% vs 8.2%).

6. When compared to individuals who did not have issues, the average operation time was substantially longer: (mean 25.0 vs 18.6 minutes).

In conclusion, the researchers concluded that males with bigger prostates or procedures lasting more than 25 minutes should be evaluated for antibacterial prophylaxis before transperineal biopsy.

Reference:

Andreas D, Nyman L, Lee J, et al. Transperineal biopsy complications and the role of antibiotic prophylaxis. Presented at the Society of Urologic Oncology 22nd annual meeting, December 1 – 3, 2021. Poster 197.