Infection rates of trans-perineal versus trans-rectal prostate biopsy: A Middle Eastern tertiary center experience-Time for a change?

INTRODUCTION

Prostate cancer is the most diagnosed cancer in men, with transrectal ultrasound-guided (TRUS) biopsy being the most frequently used method of tissue diagnosis in the past. With the introduction of the new modality of trans-perineal (TP) ultrasound-guided prostate biopsy, urologists and radiologists adopted this new technique for the decreased rate of complications such as urinary tract infections, bacteremia, sepsis and the avoidance of antimicrobial prophylaxis. We aim to compare the infectious rates of TRUS versus TP biopsy from our Middle Eastern tertiary care center.

METHODS

Retrospective data was collected on patients from our medical records from May 2019 till December 2023 at our institution. The data included adult male patients aged 18 years and above undergoing TP or TRUS prostate biopsy. Patients with positive urine culture before biopsy were excluded. Electronic medical records, pathology and laboratory reports were reviewed to collect patient-related data including age, BMI, smoking, alcohol consumption, medical history and comorbidities. In addition, variables related to the procedure type, the target lesion location, antibiotic prophylaxis, bowl preparation, number of cores taken, and laterality of the tumor were included.

RESULTS

A total of 745 patients underwent an ultrasound guided prostate biopsy performed by 6 attending urologists at our institution. Among them, 157 (21.1%) patients underwent TRUS biopsy, while 588 (78.9%) underwent TP biopsy. Within one month of the biopsy, 13 patients (1.7%) developed UTI. 6 of them had TRUS (4.1%), and 7 had TP (1.2%) with p = 0.03. Four patients required hospital admission for fever and bacteremia, all of which had undergone TRUS biopsy with hospital stay from 2-5 days receiving meropenem, ciprofloxacin, cefixime or Bactrim.

CONCLUSION

TP prostate biopsy carries a lower risk of infectious complications and requires no antibiotic prophylaxis compared to TRUS biopsy of the prostate. These results advocate the superiority of the use of TP biopsy over TRUS biopsy.