Are outpatient transperineal prostate biopsies without antibiotic prophylaxis equivalent to standard transrectal biopsies for patient safety and cancer detection rates?A retrospective cohort study in 222 patients

Abstract

Background To describe our experience with outpatient transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods In our retrospective review, we compared the TPB to TRB in our institution for outpatient prostate biopsies with local anesthesia from June 1st, 2017 to June 1st, 2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion Outpatient TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

Transperineal vs. transrectal biopsy to reduce postinterventional sepsis

“…The authors compared sepsis rates after transperineal ultrasound-guided prostate biopsy (0%) and transrectal ultrasound-guided prostate biopsy (0.8%), which were not significantly different (P ¼ 0.354) [20]. One other US institution reported procedure-related infections after transperineal ultrasound-guided prostate biopsy without antibiotics and after transrectal ultrasound-guided prostate biopsy with antibiotic prophylaxis [21]. Sepsis was defined as the systemic inflammatory response syndrome (SIRS) criteria [22,23].…”

“…Sepsis was defined as the systemic inflammatory response syndrome (SIRS) criteria [22,23]. In the cohort undergoing transperineal ultrasound-guided prostate biopsy, there was no sepsis event (0%); however, the sepsis rate was 0.9% after transrectal ultrasound-guided prostate biopsy [21].…”

“…These findings are important in terms of patient counseling and risk stratification. However, two of these series derived their transrectal ultrasound-guided prostate biopsy outcomes from procedures performed before they switched their practice to transperineal ultrasound-guided prostate biopsy [19,21], which needs to be taken into account when interpreting these findings. A current effort to gather up-to-date, high level of evidence is expected to result from the PERFECT trial, which is currently recruiting to compare morbidity of both biopsy routes as a secondary outcome [26].…”

Should we review our prophylaxis approach for increased antibiotic resistance in transrectal prostate biopsy?

“…Transrectal ultrasound-guided prostate biopsy (TRUSBx) is associated with a severe infection risk [1,2]. Although antibiotic prophylaxis usually with fluoroquinolones is routinely used, the infection rate after TRUSBx is increasing due to antibiotic resistance [1,3].…”

Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System

“…In recent years, the limitations of the original freehand technique for performing transperineal prostate biopsy have been overcome by the introduction of a purpose‐built, probe‐mounted needle guide that includes a common access cannula known as the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD). 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Following its approval by the United States Food and Drug Administration in 2016, this device facilitated the rapid adoption of transperineal prostate biopsy worldwide and led to widespread calls for the complete abandonment of the transrectal approach to prostate biopsy. 25 , 26 In this report, we provide the results of a systematic review of the available literature on the outcomes and complications of performing transperineal prostate biopsies using this novel device.…”