Infections after prostate biopsy are rare, but they do occur. Research now shows that lower than 2% of men develop a confirmed infection after a prostate biopsy, whatever the technique used.
In the United States, doctors normally insert a biopsy needle through the rectum after which into the prostate gland while watching their progress on an ultrasound machine. This is known as a transrectal ultrasound-guided biopsy (TRUS). Because the biopsy needle passes through the rectum, there's a likelihood that fecal bacteria may enter the prostate or escape into the bloodstream. For this reason, doctors normally treat the patient with antibiotics before starting the procedure.
Alternatively, the biopsy needle might be passed through the peritoneum, which is a chunk of skin between the anus and the bottom of the scrotum. These transperitoneal prostate (TP) biopsies, as they're called, are also performed with ultrasound guidance, and since they bypass the rectum, antibiotics aren't normally needed. Thus, TP biopsy helps rule out antibiotic resistance, and European clinical guidelines strongly support this approach, citing a low risk of infection.
Objectives and Methods of the Study
TP biopsy shouldn't be widely adopted within the United States, because of physicians not being aware of the procedure and requiring more training to perform it. Technology continues to enhance, and TP biopsies are increasingly being performed in office settings across the country. But questions remain about how TRUS and TP biopsy compare by way of their infectious complications.
To investigate, researchers at Albany Medical Center in New York conducted the primary randomized clinical trial comparing the risks of infection related to any method. There were results. published In February Journal of Urology.
The Albany team randomized 718 men to TRUS or TP biopsy. Almost all men who underwent TRUS biopsy (and, with some exceptions, not one of the TP-treated men) received a one-day course of antibiotics first. All biopsies were performed between 2019 and 2022 by three urologists working at affiliated and unaffiliated hospitals of the medical center.
Men were then monitored for fever, genitourinary infections, antibiotic prescriptions for suspected or confirmed infections, sepsis, and infection-related contacts with caregivers. The researchers collected data during a visit two weeks after the biopsy procedure, after which by phone over an extra 30-day period after that initial meeting.
What did the researchers find?
According to the outcomes, 1.1% of men within the TRUS group and 1.4% of men within the transperineal group were injured with confirmed infection. The difference was not statistically significant. If “possible” infections were counted (eg, antibiotic prescriptions for fever), the rates rose to 2.6% and a pair of.7% amongst men within the TRUS and TP groups, respectively.
Fever was essentially the most frequent complication, reported by six participants in each group. One participant in each group also retained noninfectious urine, requiring temporary use of a catheter. None of the boys developed sepsis or required biopsy treatment after bleeding.
The study had some limitations: Almost the entire participants were white, and so the outcomes may not apply to men from other racial and ethnic groups. Furthermore, because all men were biopsied by the identical institution, it's unclear whether these findings are generalizable to other settings. Still, the study provides reassuring evidence that each varieties of biopsies “represent safe and viable options for clinical practice,” the authors concluded.
Expert opinion
“Interestingly, the investigators did not see any difference in infectious complications, and it will be important to see if other ongoing studies report similar results,” continued Dr. Gershman. “In addition to safety, we also need to confirm whether there is a meaningful difference between the two methods in terms of cancer detection rates.”