Antibiotics prophylaxis for digital-guided transrectal tru-cut needle biopsy of the prostate

Prostate biopsy is essential to diagnose prostate cancer. The complications need to be kept in view.

To explore the outcome of prostate biopsy using Gentamicin 280 mg by intramuscular injection as prophylaxis against infection.

Patients aged over 40 years seen in Sophia Clinic Port Harcourt over a 5-year period with clinical suspicion of prostate cancer had transrectal biopsy of the prostate after written consent. Each received Gentamicin 280 mg intramuscularly one hour before biopsy without anaesthesia and without rectal washout. Biopsy was done with an 18 F Tru-cut biopsy needle guided digitally. The histology reports were assessed. Biopsy was repeated at different sessions if earlier reports were inconsistent with clinical suspicion. The patients were reviewed one week after biopsy.

One hundred and nine subjects aged 48-95 years had 111 prostate core needle biopsies. Biopsies positive for prostatic disease were 108 (97.3%) including adenocarcinoma 98 (88.3%) and benign prostatic hyperplasia (BPH) 10 (9.0%). Three specimens (2.7%) showed no prostate tissue. In 2 specimens from a patient with osteoblastic radiological features of prostate cancer, the histology report indicated BPH. On seven occasions (63%), patients had severe pain during the procedure but did not require analgesia. Transient rectal bleeding occurred in 15 patients soon after the procedure. Complications noted within a week after the procedure included fever in four patients, urinary tract infection in four, haematuria in eight, septicaemia in one and a horse-shoe perianal abscess in one.

Serious complications after transrectal Tru-cut biopsy of the prostate are uncommon. Septic complications may have been reduced by the antimicrobial prophylaxis.