Retrospective, single center evaluation of perineal prostate biopsy omitting antibiotic prophylaxis and omitting periinterventional screening for bacteriuria

Purpose The pursuit of effective and safe early detection methods for prostate cancer has led to advancements in non-invasive tools, yet the annual performance of one million prostate biopsies in the EU underscores the challenges. The transperineal approach, recommended by the EAU, offers reduced infectious complications compared to transrectal biopsies. The role of antibiotic prophylaxis in transperineal biopsies remains ambiguous, necessitating investigation due to concerns about antibiotic resistance and the impact on public health. Methods This retrospective study analyzed 636 patients who underwent transperineal prostate biopsies between January 2019 and August 2020. The primary endpoint was postinterventional infectious complications, with secondary endpoints including the general complication rate and associated risk factors. Results Among the cohort (median age 68), 12 complications were recorded, yielding a 1.9% complication rate. Infectious complications requiring hospitalization and antibiotic treatment occurred in 1.1% of cases. No identified risk factors were associated with infectious complications or post-interventional bleeding. Complications included gross hematuria, urinary retention requiring catheterization, and one case necessitating intensive care. Notably, the cohort did not systematically screen for bacteriuria, and patients with high risk for complications were not excluded. The complication rate appeared lower than reported for transrectal biopsies with antibiotic prophylaxis. Conclusion This study supports the safety of omitting antibiotic prophylaxis in transperineal prostate biopsies, showcasing a minimal infectious complication rate. The findings contribute to the ongoing discourse on antibiotic stewardship, emphasizing the need for judicious use to mitigate resistance.