Transperineal magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy under local anesthesia without antibiotic prophylaxis can be performed safely and is well-tolerated, a recent study suggests.

Of 621 men who underwent the procedure, a post-biopsy infection developed in only 4 (0.6%), Karsten Günzel, MD, of Vivantes Klinikum Am Urban Berlin in Berlin, Germany, and colleagues reported in the World Journal of Urology. Of these, 3 had to be treated as inpatients.

Patients reported their subjective pain sensation immediately after the biopsy using an analog pain scale from 0 (no pain) to 10 (worst possible pain). They reported a median perioperative pain level of 2 when local anesthesia was applied and 2 when the biopsies were performed.

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The study included the largest published patient cohort to date undergoing transperineal MRI-TRUS fusion biopsy under local anesthesia without antibiotic prophylaxis, the investigators noted.

Dr Günzel’s team noted that other studies examining the perineal biopsy approach had similar post-biopsy infection rates despite use of routine perioperative antibiotic prophylaxis, “suggesting that the use of antibiotics might be a potential overtreatment.”

“Prostate biopsy as the gold standard for the diagnosis of prostate cancer has undergone progressive evolution in recent years, from systematic random transrectal TRUS biopsy, to MRI-TRUS fusion biopsy,” the authors wrote. “Despite technical progress and high cancer detection rates, post-biopsy infections remain a major problem of the transrectal approach. Thus, an alternative access for biopsy via the perineum is widely discussed.”


Günzel K, Magheli A, Baco E, et al. Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis. Published online April 18, 2021. World J Urol. doi:10.1007/s00345-021-03699-1