Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis

• Published in: World journal of urology Vol. 39; no. 10; pp. 3861 - 3866
• Main Authors: Günzel, K., Magheli, A., Baco, E., Cash, H., Heinrich, S., Neubert, H., Schlegel, J., Schostak, M., Henkel, T., Asbach, P., Hinz, S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2021; Springer Nature B.V
• Subjects: Aged; Anesthesia; Anesthesia, Local; Antibiotic Prophylaxis - methods; Antibiotics; Biopsy; Disease prevention; Endosonography; Humans; Image-Guided Biopsy - methods; Infections; Local anesthesia; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Multiparametric Magnetic Resonance Imaging; Nephrology; Oncology; Original Article; Pain; Perineum; Prophylaxis; Prostate - pathology; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; Sepsis - epidemiology; Surgical Wound Infection - epidemiology; Urinary Tract Infections - epidemiology; Urology; Antibiotic prophylaxis; Fusion biopsy; Transperineal biopsy; Prostate; Local anesthesia
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-021-03699-1

Purpose
The aim of this study was to assess the post biopsy infection rate, feasibility and prostate cancer (PCa) detection rate (CDR) by performing transperineal MRI-TRUS fusion biopsy of the prostate (TPBx) under local anesthesia (LA) without antibiotic prophylaxis (AP).
Methods
We prospectively screened 766 men with suspicious lesions on mpMRI, an elevated PSA level or a suspect digital examination undergoing MRI-TRUS-TPBx in LA, from May 2019 to July 2020. Patients with the need for antibiotic prophylaxis or without a PI-RADS target lesion were excluded from final analyses. We reported CDR, perioperative pain (0–10) and postoperative complications. PCa with an ISUP grade ≥ 2 was classified as clinically significant PCa (csPCa).
Results
We included 621 patients with a median age of 68 years (IQR 62–74), a PSA of 6.43 ng/mL (IQR 4.72–9.91) and a prostate volume of 45 cc (IQR 32–64). In median, 4 targeted (TB) (IQR 3–4) and 6 (IQR 5–7) systematic biopsies (SB) detected in combination overall 416 (67%) PCa and 324 (52%) csPCa. Overall CDR of TB for PI-RADS 3, 4 and 5 was 26%, 65% and 84%, respectively. Patients reported a median perioperative pain level of 2 (IQR 1–3). Four patients (0.6%) developed a post biopsy infection, one experienced urosepsis.
Conclusion
Our results demonstrate that transperineal MRI-TRUS fusion-guided prostate biopsy under LA without AP is feasible, safe and well tolerated.