Abstract
BackgroundTo investigate infectious and non-infectious complications after transperineal prostate biopsy (TPB) without antibiotic prophylaxis in a multicenter cohort. Secondly, to identify whether increasing the number of cores was predictive for the occurrence of complications. Thirdly, to examine the relation between TPB and erectile dysfunction.MethodsWe analyzed a retrospective multicenter cohort of 550 patients from three different urological centers undergoing TPB without antibiotic prophylaxis. The median number of cores was 26. Demographic and clinical data were extracted by reviewing patients’ electronic medical records and follow-up data such as postoperative complications obtained by structured phone interviews. To investigate the influence of the number of cores taken on the occurrence of complications, we performed univariate and multivariate mixed effects logistic regression models.ResultsThere was no case of sepsis reported. Overall, 6.0% of patients (33/550) presented with any complication besides mild macrohematuria. In all, 46/47 (98%) complications were ≤Grade 2 according to Clavien–Dindo. In multivariate regression analyses, an increased number of cores was associated with overall complications (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02–1.14, P = 0.01) and specifically bleeding complications (OR 1.28, 95% CI 1.11–1.50, P = 0.01) but not with infectious complications (OR 1.03, 95% CI 0.97–1.10, P = 0.67). A total of 14.4% of patients referred impairment of erectile function after TPB. Of note, 98% of these men were diagnosed with prostate cancer.ConclusionsThis is the first multicenter trial to investigate complications after TPB without antibiotic prophylaxis. In our study, we found no case of sepsis. This underlines the safety advantage of TPB even without antibiotic prophylaxis and supports the ongoing initiative to abandon TRB of the prostate. A higher number of cores were associated with an increase in overall complications specifically bleeding complications, but not with infectious complications. Post-biopsy erectile dysfunction was mainly present in patients diagnosed with PCa.
Highlights
Until recently, transrectal biopsy (TRB) has been the real-world standard for the histopathological diagnosis of prostate cancer (PCa) [1]
Prostate volume by MRI, prostate-specific antigen (PSA), number of biopsy cores, history of previous biopsy, multiparametric MRI (mpMRI) findings according to the Prostate Imaging: Reporting and Data System (PI-RADS) and histopathological prostate biopsy findings according to the classification of the International Society of Urological Pathology (ISUP)
An alarming increase of potentially life-threatening infectious complications has been reported after TRB despite the standard use of antibiotic prophylaxis [2, 3]
Summary
To investigate infectious and non-infectious complications after transperineal prostate biopsy (TPB) without antibiotic prophylaxis in a multicenter cohort. An increased number of cores was associated with overall complications (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02–1.14, P = 0.01) and bleeding complications (OR 1.28, 95% CI 1.11–1.50, P = 0.01) but not with infectious complications (OR 1.03, 95% CI 0.97–1.10, P = 0.67). This underlines the safety advantage of TPB even without antibiotic prophylaxis and supports the ongoing initiative to abandon TRB of the prostate. A higher number of cores were associated with an increase in overall complications bleeding complications, but not with infectious complications.
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