PD11-10: Complications after Transperineal Prostate Biopsy without Antibiotic Prophylaxis: a Contribution to the Effort to Control the Spread of Antibiotics Resistance

Renée Hogenhout*, Henk B. Luiting, Daniël F. Osses, Monique J. Roobol, Rotterdam, Netherlands

Introduction: Currently, only a few small, non-randomized and sometimes retrospective studies compared the infectious complications (IC) rates after transperineal prostate biopsy (TPB) with antibiotic prophylaxis (AP) to TPB without AP. A systematic review including these studies showed no difference (Castellani et al., J. Urol. 2021). Ideally, an RCT should be conducted for high level of evidence. This is however unrealistic: the overall low rate of IC will require a very large sample size. In addition, if a true difference will be found, it can be debated whether this, probably small, difference is clinically relevant given the expected unacceptably high number needed to treat. Here, we aim to determine if the IC rate is acceptable for TPB without AP when compared to transrectal biopsy (TRB) with AP as the former first but still generally accepted choice.

Methods: We prospectively included men who underwent prostate biopsy in Erasmus MC between Nov 2017 – Sept 2021: TRB with oral AP (standard ciprofloxacin 1-d regimen) until Dec 2019 and thereafter TPB without AP under local anesthesia with disinfection of the perineal skin using chlorhexidine. All men were contacted by phone 4 wks after biopsy to ask for complications by structured interviews. From Jun 2020 pain scores were recorded using the Numerical Rating Scale (NRS).

Results: In total, 435 men were included of which 49% had TRB and 51% had TPB (table 1). The infectious complication rate was significantly lower after TPB compared to TRB (6.1% vs 2.3%, p=0.044). More men experienced hematuria >3dys after TPB, although without any severe consequences (i.e. cloth retention, hospital admission). Median pain scores were low, especially for prostate biopsy itself after local anesthesia (median NRS 2, IQR 0-3).

Conclusions: In this prospective study the IC rate after TPB without AP was significantly lower than after TRB with AP. High level of evidence is lacking on whether TPB with AP will further reduce the IC rate. However, most important is that TPB without AP after proper local anesthesia is already beneficial compared to TRB with AP as the former first choice. Furthermore it contributes to the effort to control the spread of antibiotics resistance. Hence, TPB without AP could therefore be an acceptable biopsy strategy.

Source of Funding: None.