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

Majdee Islam,Nathan Clark,Alan Quach,Rodrigo Donalisio Da Silva,Leticia Nogueira,Diedra Gustafson,Fernando J Kim

doi:10.1186/s13037-021-00303-8

Majdee Islam, Nathan Clark + Show 5 more

Open Access

https://doi.org/10.1186/s13037-021-00303-8

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Abstract

BackgroundTo 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.MethodsIn 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.ResultsTwo 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.ConclusionOutpatient 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.

Highlights

Prostate cancer accounts for almost one in five new cancer diagnoses [1]
There is no significant data on transperineal biopsy (TPB) performed without preprocedure antibiotics compared to transrectal biopsy (TRB) performed in the United States
Our study showed transperineal biopsy had a lower rate of urinary retention post-biopsy than transrectal biopsy, at 0.9 and 3.6%, respectively

Summary

Introduction

Prostate cancer accounts for almost one in five new cancer diagnoses [1]. In the last couple decades, there has been significant advances in early prostate cancer detection [2, 3]. Transperineal biopsy (TPB), an alternative option to TRB for outpatient prostate biopsy, is not widely used in the outpatient setting, especially without MRI-guidance or with saturation, in the US [8]. This is likely due to previous freehand techniques being difficult to perform outpatient until recent FDA clearance of a single access needle with PrecisionPointTM (Perineologic) [9]. The literature elicits cancer detection, prediction of final cancer laterality, procedure time, and cost of outpatient procedure itself being comparable between TPB and TRB [7, 8, 10].

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