Transperineal Prostate Biopsy Safe, Data Show

By John Schieszer

Transperineal biopsies may be performed in an office under local anesthesia, with low rates of infectious complications even in patients who do not receive prophylactic antibiotics, according to a new retrospective study presented at Society of Urologic Oncology 22nd annual meeting.

Patients with larger prostates and longer procedure times are more likely to experience post-biopsy complications.

“We found in the study that the overall rate of infectious complications after transperineal biopsy without antibiotic prophylaxis was 0.8%,” said urologist Mariela Martinez, MD, from Maimonides Medical Center, Brooklyn, New York. “The rate of infectious complications requiring hospital admission for IV antibiotics was 0.5%. This finding was surprising because the rate of post-biopsy infections was low even though the majority of patients in our cohort did not receive pre-procedural antibiotics.”

Studies have demonstrated transperineal biopsy can help lower the rate of post-biopsy urinary tract infections (UTIs) and sepsis, but a consensus regarding the use of antibiotic prophylaxis for transperineal biopsy has yet to be developed. Dr Martinez’s team examined the complications of transperineal biopsy with regards to antibiotic use at a single institution.

The retrospective review included 372 patients who underwent 12-core transperineal biopsies from November 2017 and September 2020 (298 in the office under local anesthesia and 67 in an operating room under general anesthesia). The mean age of the men was 64 years (range 41-87 years). Use of pre-procedure antibiotics was the surgeon’s discretion. A total of 51 patients (14%) received prophylactic antibiotics.

Complications developed in 40 patients (10.8%): 29 (9.7%) of 298 in the in-office group and 11 (16.4%) of 67 in the operating room group. Overall, urinary retention occurred in 6 patients (1.6%) and mild hematuria in 24 (6.5%). Infectious complications developed in 3 patients (0.8%), with 2 requiring intravenous antibiotics.

Patients with prostate volumes greater than 50 grams experienced significantly higher rates of complications compared with those who had smaller volumes (18.7% vs 8.2%). The average procedure time was significantly longer for patients who had complications compared with those without complications: (mean 25.0 vs 18.6 minutes).

The researchers concluded that men with larger prostates or with procedure times longer than 25 minutes should be considered for antibiotic prophylaxis prior to transperineal biopsy.

Jim C. Hu MD, MPH, professor of urologic oncology and vice chair of clinical research at Weill Cornell Medicine in New York, New York, said these procedures do not require prophylactic antibiotics. However, if the use of prophylactic antibiotics can reduce the proportion of infectious complications to 0%, it could have a significant impact given that prostate biopsies are performed more than 1 million times annually in the United States. “More study is needed, but the authors are to be congratulated for this retrospective study,” Dr Hu said. “As active surveillance is used more widely and the need for serial biopsies, offering personalized cancer that significantly reduces infection risks and the need for antibiotic prophylaxis for transperineal biopsies improves value-based care.”

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.

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