JU INSIGHT: The Effect of Different Types of Prostate Biopsy Techniques on Post-Biopsy Infectious Complications

By: Sofie C. M. Tops, MSc; Justin G. A. Grootenhuis, MSc; Anouk M. Derksen, MSc; Federica Giardina, PhD; Eva Kolwijck, MD, PhD; Heiman F. L. Wertheim, MD, PhD; Diederik M. Somford, MD, PhD; J. P. Michiel Sedelaar, MD, PhD | Posted on: 01 Jul 2022

Tops SCM, Grootenhuis JGA, Derksen AM et al: The effect of different types of prostate biopsy techniques on post-biopsy infectious complications. J Urol 2022; 208: 109.

Study Need and Importance

Infection rates after transrectal prostate biopsy (PB) are rising due to growing numbers of fluoroquinolone-resistant rectal flora. Alternatives must be sought as these infections can be severe and lead to sepsis. We compared infectious complication rates between different PB techniques with various number of biopsy cores.

Table. Main findings

Transrectal Ultrasound-
Guided PB±Targeted Biopsies ≥10 Biopsy Cores
Transrectal Targeted MRI-TRUS Fusion or TRUSPB ≤4 Biopsy Cores Transrectal Targeted In-Bore MRI-Guided PB ≤4 Biopsy Cores Transperineal MRI-TRUS Fusion Guided PB ≥10 Biopsy Cores
% Infectious complications within 7 days post-biopsy (No.), adjusted OR (95% CI) 4.0 (104) 1.0 (4), 0.41 (0.12–1.12) 2.1 (19), 0.68 (0.37–1.20) 1.3 (4), 0.29 (0.09–0.73)
% Infectious complications within 30 days post-biopsy (No.), adjusted OR (95% CI) 4.8 (125) 1.3 (5), 0.42 (0.14–1.04) 2.3 (21), 0.58 (0.33-0.99) 2.6 (8), 0.46 (0.19–0.96)
% Hospitalization within 7 days post-biopsy (No.) 2.8 (73) 0.3 (1) 1.2 (11) 0.0 (0)
% Bacteremia within 7 days post-biopsy (No.) 1.0 (25) 0.3 (3) 0.0 (0) 0.0 (0)

TRUS, transrectal ultrasound.

What We Found

In total, 4,233 PBs in 3,707 patients were included. After transrectal ultrasound-guided PB (TRUSPB; 12±1.4 biopsy cores), 4.0% (2,607) of all patients had infectious complications within 7 days post-biopsy. Transperineal magnetic resonance imaging (MRI)-ultrasound fusion guided PB (16±3.7 biopsy cores) was associated with significantly lower infection rates than TRUSPB (adjusted OR: 0.29 [0.09–0.73] 95% CI). Transrectal targeted MRI-ultrasound fusion guided PB (3.1±0.8 biopsy cores) and transrectal targeted in-bore MRI guided PB (2.8±0.8 biopsy cores) also showed fewer infectious complications than TRUSPB (adjusted OR: 0.41 [0.12–1.12] 95% CI and 0.68 [0.37–1.20] 95% CI, respectively). Similar results were found for infectious complications within 30 days post-biopsy, hospitalization and bacteremia (see Table). Prophylaxis-resistant bacteria were found in 62% and 78% of the bacteria isolated from urine cultures of patients within 7 and 30 days post-biopsy, respectively.

“Prophylaxis-resistant bacteria were found in 62% and 78% of the bacteria isolated from urine cultures of patients within 7 and 30 days post-biopsy, respectively.”


Differences in the risk of infectious complications when taking different numbers of biopsy cores in transperineal PB were not assessed. Due to the retrospective nature of our study, some post-biopsy infections might have been missed. However, we do not expect this to differ between the cohorts.

Interpretation for Patient Care

Post-biopsy infections can be reduced using a transperineal approach. Reducing the number of biopsy cores by using a transrectal targeted PB only approach could be a reasonable alternative. Diagnostic accuracy should be decisive here. In view of the high percentage of prophylaxis-resistant bacteria isolated from post-biopsy urine cultures, culture-based prophylaxis could potentially also contribute to the reduction of infectious complications.