Antibiotic Prophylaxis Is Not Required Before MRI-Guided Transperineal Prostate Biopsy

To evaluate rates of infectious and non-infectious complications after transperineal prostate biopsy (TPBx) without antibiotic prophylaxis (ABP) and to identify potential risk factors for post-biopsy infections.

We conducted an observational cohort study among patients who underwent TPBx without ABP at two high-volume diagnostic prostate cancer centers in an outpatient setting between February 2020 and October 2023. The primary outcome was post-TPBx infection, defined as an antibiotic prescription for urinary tract infection within 2 weeks post-biopsy or inpatient care for infection within 30 days. The secondary outcome was any non-infectious complication within 2 weeks after biopsy. We analyzed the following factors in relation to post-TPBx infection: age, prostate-specific antigen (PSA) level, prostate volume, PSA density, number of biopsy cores, diabetes mellitus, an indwelling catheter, and immunosuppressant use.

A total of 1966 TPBx procedures in 1814 patients were included. Eighteen patients (0.9%) developed a post-biopsy infection; four (0.2%) required hospital admission and were treated with intravenous antibiotics. None of them required admission to the intensive care unit. The remaining 14 patients (0.7%) were treated in an outpatient setting and received oral antibiotics. We found no significant risk factors associated with infections. Non-infectious complications were observed in 19 patients (1.0%).

Post-TPBx infections without ABP were rare, occurring in less than 1.0% of cases, even among patients with diabetes or an indwelling catheter. Our results suggest that ABP may be safely omitted in patients undergoing TPBx for prostate cancer detection, even in patients with traditional risk factors.