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Sandy Srinivas, MD


Antibiotic Stewardship: Transperineal vs Transrectal Prostate Biopsy

By: Celeste L. Dixon
Posted: Tuesday, March 5, 2024

Evidence to support the infection prevention and efficacy benefits of transperineal prostate biopsy under local anesthesia, vs the “inherently contaminated” transrectal method, was presented by Jim C. Hu, MD, MPH, of Weill Cornell Medicine, New York, and colleagues at the 2024 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium (Abstract 261). Results of their multicenter, randomized trial involving more than 500 men suspected to have prostate cancer indicated the office-based transperineal biopsies are not only tolerable and do not compromise cancer detection, but they are likely to reduce infection risk without using antibiotic prophylaxis.

Their findings, further stated the team, point to this innovative biopsy strategy “as the new standard of care for prostate cancer detection, with per-patient and population-based antibiotic stewardship and health-care cost benefits.” Currently, however, transrectal prostate biopsy is the predominant approach to prostate cancer detection in the United Stated and internationally.

Of 567 men who were randomly assigned to groups and included in the intent-to-treat analysis, 0 in the transperineal arm vs 4 in the transrectal arm developed infections (P = .059). Rates of urinary retention and significant bleeding were very low and similar between the groups, they added.

“Importantly, detection of clinically significant cancer was similar: 53% with transperineal vs 50% with transrectal (P = .6),” noted Dr. Hu and co-investigators. “Participants undergoing transperineal biopsy [did] experience worse periprocedural pain (P = .002), but the effect was small and resolved by 7 days.”

Disclosure: For full disclosures of the study authors, visit

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