Northwestern MedicineExamining Infection Rates in Prostate Cancer Biopsies

Comparative Study Reveals Similar Infection Rates in Transperineal and Transrectal Prostate Biopsies, Highlighting Potential for Antibiotic-Free Approaches

A recent Northwestern Medicine study published in European Urology compared infection rates between two prostate cancer biopsy methods: transperineal biopsy without preventive antibiotics and transrectal biopsy with targeted antibiotic prophylaxis. The research, led by Dr. Edward Schaeffer, found minimal and similar infection rates for both approaches, suggesting safe alternatives for prostate cancer detection and monitoring.

Key Points:

• The study involved 658 patients across 10 academic medical centers.
• Patients were randomized to undergo either transperineal biopsy without antibiotics or transrectal biopsy with targeted antibiotic prophylaxis.
• Post-biopsy infection rates were measured after seven days.
• Four patients in the transrectal biopsy group reported infections, while zero infections occurred in the transperineal group.
• Infections were manageable with oral antibiotics or brief hospitalization, without ICU admission or sepsis.
• Detection rates of clinically significant cancer were comparable: 53% in the transperineal group and 50% in the transrectal group.
• The transperineal approach can be performed under local anesthesia without antibiotics.
• Targeted antibiotic prophylaxis for transrectal biopsies was developed by Dr. Anthony J. Schaeffer.
• Secondary outcomes included cancer detection, noninfectious complications, and biopsy-related pain and discomfort.
• The emergence of antibiotic-resistant bacteria has increased the risk of severe infection in transrectal biopsies.
• Researchers are currently evaluating whether either approach offers advantages based on lesion location as detected by MRI.
• Future studies will investigate prostate biopsy infectious complications in patients with diagnosed cancer undergoing active surveillance.

“Prostate biopsy is safe — it can be safely done without antibiotics with a transperineal approach or with directed antibiotics and offer a patient an excellent diagnostic option to detect or monitor their cancer.”
– Edward M. Schaeffer, MD, PhD, Chair, Dept. of Urology

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