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The transition from transrectal to transperineal prostate biopsy without antibiotic prophylaxis: Cancer detection rates and complication rates

Prostate Cancer and Prostatic Diseases volume 26, pages 581–587 (2023)Cite this article

Subjects

Abstract

Background

Currently, transperineal prostate biopsy (TPB) is preferred over transrectal biopsy (TRB) because of less infectious complications and improved clinically significant prostate cancer (csPCa) detection. However, literature on omitting antibiotic prophylaxis (AP) is limited. Furthermore, previous studies did not include invasive cribriform growth/intraductal carcinoma (CR/IDC) in the definition of csPCa. Therefore, we compared the infectious complication rates between TPB without AP and TRB with AP, and we compared the csPCa detection rates between TPB and TRB including CR/IDC in the definition of csPCa.

Methods

We included 729 men who were referred to Erasmus MC Cancer Institute between 2013-2019 for MRI/TRUS fusion-guided prostate biopsy. Up to 2019, TRB was performed with AP, thereafter TPB was performed without AP. Data on complications were collected prospectively. We compared csPCa detection rates between the biopsy routes using multivariable logistic regressions for men without previous PCa diagnosis and mixed logistic regression for men on active surveillance. To compare the csPCa detection rates in anterior and apical lesions, and the complications rates between the biopsy routes, we used the chi-square test.

Results

Overall, we found no difference in csPCa detection between TPB and TRB (odds ratio 1.0, 95%-confidence interval (CI) 0.62–1.76, p = 0.9; for men on active surveillance: odds ratio 1.05, 95%-CI 0.58–1.88, p = 0.9). This was confirmed in anterior and apical lesions although absolute numbers were low. TPB reduced infectious complications with fever compared to TRB (1.1% vs 5.1%, difference = 4.0%, 95%-CI 1.0–7.9, p = 0.010).

Conclusions

TPB has no different csPCa detection rate from TRB taking CR/IDC into account. TPB is, however, preferable because of less infectious complications, even if AP is omitted.

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Fig. 1: Flowchart presenting the selection of patients included in the primary analyses and sensitivity analyses on csPCa detection.

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Code availability

The statistical code is available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to acknowledge Conja G.A.M. Franken-Raab and Marlies E. van Slooten-Midderigh for their effort on data collection; Ivo I. de Vos, Margaretha A. van der Slot, Henk B. Luiting, Daniel F. Osses, Arnout R. Alberts, Jan F.M. Verbeek, Frank-Jan Drost, and Leonard P. Bokhorst for their clinical work; and Martijn B. Busstra for his clinical supervision.

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Authors and Affiliations

  1. Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Renée Hogenhout, Sebastiaan Remmers & Monique J. Roobol

  2. Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands

    Geert J. L. H. van Leenders

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  1. Renée Hogenhout
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  2. Sebastiaan Remmers
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Contributions

Study concept and design: RH, SR, GJLHL, MJR. Data collection: RH. Statistical Analysis and interpretation of results: RH, SR, MJR. Drafting of the manuscript: RH, SR. Critical revision of the manuscript for intellectual content: RH, SR, GJLHL, MJR. Obtaining funding: None. Administrative, technical, or material support: GJLHL. Supervision: MJR.

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Correspondence to Renée Hogenhout.

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Hogenhout, R., Remmers, S., van Leenders, G.J.L.H. et al. The transition from transrectal to transperineal prostate biopsy without antibiotic prophylaxis: Cancer detection rates and complication rates. Prostate Cancer Prostatic Dis 26, 581–587 (2023). https://doi.org/10.1038/s41391-022-00641-3

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