Prostate biopsies without antibiotic cover – are we there yet?
Reviewed by Karthik Rajan

Transperineal (TP) prostate biopsies are widely replacing the traditional transrectal route due to definite evidence of reduced infective complications. TP biopsies are usually performed with a single dose of antibiotic pre-procedure in most centres. In this article the authors attempt to assess the outcomes of TP biopsies without prophylactic antibiotics, which they have been doing in uncomplicated cases since 2016. They performed a retrospective study of cases from 2012 to 2020 comparing the two groups for infectious complications. Nine hundred and eighty-eight biopsies were included with 538 cases (54.4%) receiving prophylaxis and 450 (48.6%) not. All the biopsies were performed free hand using angio catheters up to 2016 (574 patients) and PrecisionPoint™ Transperineal Access System afterwards (414 patients). It should be noted that 498 patients in the prophylaxis group had their biopsy before 2016, with only 40 additional patients since then. The baseline characteristics showed a significant difference between the two groups in terms of age (67 vs. 69 years; P<0.001), abnormal digital rectal examination (DRE) (13% vs. 5%; P<0.001) and history of multi-parametric MRI (15% vs. 31%; P<0.001). None of these factors bear any direct relevance to infection and can be safely ignored as confounders. There were zero readmissions in either group. The prophylaxis group had no complications within one week while there was a total of three complications in the no-prophylaxis group (0.66%, P=0.09). Two were culture positive urinary tract infections (UTIs) and one urinary retention. This study has one major shortcoming in terms of use of different techniques between the two groups which could be a potential confounder. However, the low rate of infective complications in a large study population cannot be ignored. The authors have certainly provided a basis for design of further prospective studies to answer this question.

Outcomes of freehand transperineal prostate biopsy with omission of antibiotic prophylaxis.
Setia SA, Smith J, Cendo D, et al.
BJU INTERNATIONAL
2021; Epub ahead of print.