Reduced Rate of Complications With Transperineal Prostate Biopsy: Real-world Data From a National Cohort Derived From the Danish Prostate Cancer Registry

Real-world data from the Danish National Cancer Register demonstrate a reduction in hospitalization rates from 6% to 1% following the transition from transrectal to transperineal prostate biopsy, even after abandoning routine antibiotic prophylaxis. Prostate biopsy remains the diagnostic gold standard for prostate cancer despite advances in magnetic resonance imaging (MRI) and prostate-specific membrane-antigen positron emission tomography imaging. Transrectal (TR) biopsy is associated with a substantial risk of infection and hospitalization. With biopsy-related infections rising globally, improvements in biopsy technique are urgently needed. The aim of this study was to assess the impact of the transition to transperineal (TP) biopsy on hospitalization rates. We analyzed data from the Danish Prostate Cancer Registry on all-cause hospitalizations within 7 d after biopsy according to procedure type, using logistic regression with adjustments for age, comorbidity, region of residence, prostate-specific antigen, International Society of Urological Pathologists grade, risk group, MRI use, and stratification on year of diagnosis. We identified 19 456 men diagnosed with prostate cancer between 2020 and 2024. During the study period, TP biopsy use increased from <1% in 2020 to 87% in 2024. Concurrently, postbiopsy hospitalizations decreased from 6.5% to 1.1%. Compared with the TR approach, the TP technique was associated with a substantially lower risk of hospitalization (adjusted odds ratio 0.17; 95% confidence interval 0.12–0.22). The decrease in admissions occurred despite discontinuation of routine antibiotic prophylaxis with TP procedures. Hospitalization for any reason within 7 d was recorded, but specific infectious complications could not be identified, and minor events managed outside hospitals were not captured. Patients with negative or repeat biopsies were not included in the database. The transition from TR to TP prostate biopsy in Denmark was associated with a substantial and sustained reduction in postprocedural hospital admissions in individual patients who had undergone the TP procedure. This population-based study provides real-world evidence on complication rates following the transition from transrectal to transperineal (TP) prostate biopsy. Adoption of the TP technique was associated with a substantial reduction in 7-d postbiopsy hospitalizations (from 6% to 1%), despite discontinuation of routine antibiotic prophylaxis. These findings underscore the safety advantages of the TP approach and support its establishment as the clinical gold standard.