A LARGE single-centre study has demonstrated that transperineal prostate biopsy (TPPB) performed under local anaesthesia (LA) without antibiotic prophylaxis is both safe and diagnostically robust, offering a practical outpatient alternative to traditional transrectal biopsy.
Between January 2015 and April 2024, researchers evaluated 763 consecutive patients who underwent freehand, MRI/ultrasound fusion-guided TPPB. Among these, 538 patients received no antibiotic prophylaxis. Pain scores, complications, and cancer detection rates were assessed using validated clinical measures, including the visual analogue scale (VAS) and the Clavien-Dindo classification.
High Diagnostic Yield of Transperineal Prostate Biopsies
In the antibiotic-free cohort, the overall cancer detection rate (CDR) was 61.7%, with clinically significant prostate cancer (International Society of Urological Pathology grade ≥2) identified in 47.4% of cases. When systematic and targeted sampling were combined, diagnostic accuracy was maximised, yielding a CDR of 65.9% (p = 0.023).
Procedure tolerability was high: mean VAS pain score was 2.7, and 91.6% of patients reported no or only mild discomfort. These findings reinforce the feasibility of performing TPPB comfortably in an office-based setting using local anaesthesia alone.
No Infectious Complications Observed
Notably, no infectious complications occurred in any of the 538 patients who underwent biopsy without antibiotic coverage. Overall complication rates were low (1.1%), with urinary retention (0.9%) being the most common event, predominantly in men with prostate volumes >50 mL.
A Shift Toward Safer, Cost-Efficient Practice
The authors conclude that freehand TPPB under local anaesthesia, without antibiotics, offers a safe, effective, and cost-efficient diagnostic pathway for prostate cancer detection. By eliminating prophylactic antibiotics, the approach aligns with global efforts to prevent antimicrobial resistance and may reduce healthcare costs and post-biopsy morbidity.
As transperineal access continues to gain traction, this study provides compelling evidence supporting broader adoption of outpatient, antibiotic-free TPPB as a new standard of care in prostate cancer diagnostics.
Reference
Lenart S et al. Accuracy and safety of in-office transperineal freehand cognitive fusion prostate biopsy under local anaesthesia without antibiotic prophylaxis. Sci Rep. 2025; 2025;15:39451.
