Are Transperineal Prostate Biopsies the Key to Minimizing Infection Risks?
Prostate biopsies are a standard diagnostic tool for detecting prostate cancer, typically performed when elevated prostate-specific antigen (PSA) levels or abnormal digital rectal exam findings suggest abnormalities such as a lump or irregularity. Over the years, two primary methods for these biopsies have emerged—transrectal (TRBx) and transperineal (TPBx)— with the latter having gained tremendous traction in recent years, particularly for its lower risk of infectious complications. 1 2
But can this technique truly minimize infection risks and redefine the standard of care for prostate biopsies? Let's explore how the transperineal biopsy is revolutionizing urological care and why it's becoming the preferred choice for many healthcare providers because of patient safety and infection prevention.
Understanding the Two Approaches to Prostate Biopsy: Transrectal vs. Transperineal
Transrectal Approach: involves inserting the biopsy needle through the rectal wall into the prostate gland. While this has been the traditional approach for decades, TRBx carries a notable risk of infection due to the needle passing through the bacteria-rich environment of the rectal mucosa. 1 2
Transperineal Approach: involves inserting the biopsy needle through the perineum, the area of skin between the scrotum and anus. This alternative route bypasses the rectum entirely, significantly reducing the risk of infections and sepsis. 1 2
Why Infection Risks Matter in Prostate Biopsies
One of the main risks associated with TRBx stems from its direct access through the rectum, where bacteria often resides. Despite the use of antibiotics, these bacteria can cause severe post-biopsy complications, including urinary tract infections (UTIs) and sepsis. 1 2
The global rise in antibiotic-resistant bacteria further exacerbates this issue, forcing the medical community to reconsider safer alternatives like transperineal biopsies. 1
More Evidence Behind Transperineal Biopsies
A growing body of research highlights TPBx as the superior method for reducing health risks – including fever and infection - during prostate biopsies. One study, published in China in 2023, found that in a study of 452 patients, only 1% of TPBx patients developed fevers after TPBx (compared to 4.1% who received TRBx). 3 Meanwhile, a 2014 study by Grummet analyzed 16 series of transperineal biopsies, across a total of 6,609 patients, and found that only 0.076% experienced sepsis – reinforcing the safety of TPBx in comparison to TRBx with regards to infection prevention. 2
Below are some other, additional studies that illustrate the advantages of TPBx:
Developed in collaboration with clinicians, CIVCO’s TP Pivot Pro disposable needle guide supports a freehand, minimally invasive approach to ultrasound-guided transperineal prostate biopsies. TP Pivot Pro offers full access to the prostate gland through its innovative pivoting mechanism. This design allows for needle angulation of ±20 degrees from the initial insertion path, enabling access to all areas of the prostate—including the anterior zone, where cancer is often found (and more difficult to reach with other freehand methods) —without withdrawing the needle from the guide or patient.
A Path Forward for Prostate Biopsies
The evidence underscores that transperineal biopsies are not just a viable alternative to transrectal methods but are, in many cases, a safer and more effective option. With reduced infection risks, broader diagnostic capabilities, and innovations like TP Pivot Pro simplifying the process, TPBx is setting a new benchmark in prostate biopsy procedures. To watch the TP Pivot Pro in action, visit here.
References:
#1: Standards of Care Changing for Prostate Cancer Diagnosis? (Cleveland Clinic) https://consultqd.clevelandclinic.org/standards-of-care-changing-for-prostate-cancer-diagnosis
#2: Grummet, J. P., Weerakoon, M., Huang, S., Lawrentschuk, N., Frydenberg, M., Moon, D. A., O’Reilly, M., & Murphy, D. (2014). Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU International, 114(3), 384–388. https://doi.org/10.1111/bju.12536 https://pubmed.ncbi.nlm.nih.gov/24612341/
#3: Lu, M., Luo, Y., Wang, Y., Yu, J., Zheng, H., & Yang, Z. (2023). Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients. BMC Urology, 23(1). https://doi.org/10.1186/s12894-023-01176-y https://pubmed.ncbi.nlm.nih.gov/36709292/
#4: Pepdjonovic, L., Tan, G. H., Huang, S., Mann, S., Frydenberg, M., Moon, D., Hanegbi, U., Landau, A., Snow, R., & Grummet, J. (2017). Zero hospital admissions for infection after 577 transperineal prostate biopsies using single-dose cephazolin prophylaxis. World Journal of Urology, 35(8), 1199–1203. https://doi.org/10.1007/s00345-016-1985-1 https://pubmed.ncbi.nlm.nih. gov/27987032/
#5: Stefanova, V., Noakes, J., Buckley, R., Flax, S., Spevack, L., Hajek, D., Tunis, A., Lai, E., Loblaw, A., Golda, N., Persaud, B., Spevack, K., Peltz, J., Deif, H., Jacobs, I., Margau, R., Raphael, S., Morton, G., Cheung, P., et al. (2019). Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability. The Journal of Urology, 201(6), 1121–1126. https://doi.org/10.1097/JU.0000000000000156 https://pubmed.ncbi.nlm.nih.gov/30835607/
#6: Huang, G.-L., Kang, C.-H., Lee, W.-C., & Chiang, P.-H. (2019). Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study. BMC Urology, 19(1), 1–8. https://doi.org/10.1186/s12894-019-0539-4 https://pubmed.ncbi.nlm.nih.gov/31660936/
#7: Honoré, A., Moen, C. A., Juliebø-Jones, P., Reisaeter, L. A. R., Gravdal, K., Chaudhry, A. A., Rawal, R., Sandøy, A., & Beisland, C. (2024). Transitioning from transrectal to transperineal prostate biopsy using a freehand cognitive approach. BJU International, 133(3), 324–331. https://doi.org/10.1111/bju.16237 https://pubmed.ncbi.nlm.nih.gov/38009392/
#8: Mian, B. M., Feustel, P. J., Aziz, A., Kaufman, R. P., Bernstein, A., Avulova, S., & Fisher, H. A. G. (2024). Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE PC Randomized Clinical Trial. The Journal of Urology, 211(2), 205–213. https://doi.org/10.1097/JU.0000000000003788 https://pubmed.ncbi.nlm.nih.gov/37976319/
#9: PanzoneJ. Byler T. Bratslavsky G. & Goldberg H. (2022). Transrectal ultrasound in prostate cancer: current utilization integration with Mpmri Hifu and other emerging applications. Cancer Management and Research 1209–1228. https://pubmed.ncbi.nlm.nih.gov/35345605/
COPYRIGHT © 2025. ALL RIGHTS RESERVED. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. ALL OTHER TRADEMARKS ARE THE PROPERTY OF THEIR RESPECTIVE OWNERS. ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANADIAN LAW. PRINTED IN USA. 2025M-3426 REV. 1
But can this technique truly minimize infection risks and redefine the standard of care for prostate biopsies? Let's explore how the transperineal biopsy is revolutionizing urological care and why it's becoming the preferred choice for many healthcare providers because of patient safety and infection prevention.
Understanding the Two Approaches to Prostate Biopsy: Transrectal vs. Transperineal
Transrectal Approach: involves inserting the biopsy needle through the rectal wall into the prostate gland. While this has been the traditional approach for decades, TRBx carries a notable risk of infection due to the needle passing through the bacteria-rich environment of the rectal mucosa. 1 2Transperineal Approach: involves inserting the biopsy needle through the perineum, the area of skin between the scrotum and anus. This alternative route bypasses the rectum entirely, significantly reducing the risk of infections and sepsis. 1 2
Why Infection Risks Matter in Prostate Biopsies
One of the main risks associated with TRBx stems from its direct access through the rectum, where bacteria often resides. Despite the use of antibiotics, these bacteria can cause severe post-biopsy complications, including urinary tract infections (UTIs) and sepsis. 1 2
The global rise in antibiotic-resistant bacteria further exacerbates this issue, forcing the medical community to reconsider safer alternatives like transperineal biopsies. 1
More Evidence Behind Transperineal Biopsies
A growing body of research highlights TPBx as the superior method for reducing health risks – including fever and infection - during prostate biopsies. One study, published in China in 2023, found that in a study of 452 patients, only 1% of TPBx patients developed fevers after TPBx (compared to 4.1% who received TRBx). 3 Meanwhile, a 2014 study by Grummet analyzed 16 series of transperineal biopsies, across a total of 6,609 patients, and found that only 0.076% experienced sepsis – reinforcing the safety of TPBx in comparison to TRBx with regards to infection prevention. 2
Below are some other, additional studies that illustrate the advantages of TPBx:
- Australia (2017):After performing 577 transperineal biopsies with single-dose cephazolin prophylaxis, researchers at the World Journal of Urology reported:
- Zero hospital admissions for infection.
- Infection-free outcomes in nearly all patients, with only one developing manageable prostatitis. 4
- Canada (2019): A study in the Journal of Urology involved 1,287 patients undergoing TPBx with local anesthesia:
- No documented cases of urosepsis or mortality.
- A post-biopsy infection rate of just 0.3%. 5
- Taiwan (2019): A comparative study published in BMC Urology divided 238 patients into transperineal and transrectal groups. Results showed:
- 0% of TPBx patients experienced sepsis, compared to 6.4% in the TRBx group
- Only 2.2% of TPBx patients reported UTIs, far lower than the 12% seen in TRBx patients. 6
- Norway (2024): Data from the British Journal of Urology demonstrated that, in a study of 1,915 patients who ultimately underwent a total of 2,337 prostate biopsy sessions:
- 5% of TRBx patients experienced urosepsis, while TPBx patients had zero cases.
- TPBx was determined to result in a significant reduction in complications and hospital re-admissions. 7
- United States (2024): A study of 763 men – 351 of whom received transrectal prostate biopsies with 1-day antibiotic prophylaxis, 367 of whom received transperineal prostate biopsies without routine prophylaxis – published in The Journal of Urology found that:
- Infectious complications occurred in 2.6% of the transrectal group and 2.7% of the transperineal group. 8
Developed in collaboration with clinicians, CIVCO’s TP Pivot Pro disposable needle guide supports a freehand, minimally invasive approach to ultrasound-guided transperineal prostate biopsies. TP Pivot Pro offers full access to the prostate gland through its innovative pivoting mechanism. This design allows for needle angulation of ±20 degrees from the initial insertion path, enabling access to all areas of the prostate—including the anterior zone, where cancer is often found (and more difficult to reach with other freehand methods) —without withdrawing the needle from the guide or patient.
A Path Forward for Prostate Biopsies
The evidence underscores that transperineal biopsies are not just a viable alternative to transrectal methods but are, in many cases, a safer and more effective option. With reduced infection risks, broader diagnostic capabilities, and innovations like TP Pivot Pro simplifying the process, TPBx is setting a new benchmark in prostate biopsy procedures. To watch the TP Pivot Pro in action, visit here.
References:
#1: Standards of Care Changing for Prostate Cancer Diagnosis? (Cleveland Clinic) https://consultqd.clevelandclinic.org/standards-of-care-changing-for-prostate-cancer-diagnosis
#2: Grummet, J. P., Weerakoon, M., Huang, S., Lawrentschuk, N., Frydenberg, M., Moon, D. A., O’Reilly, M., & Murphy, D. (2014). Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU International, 114(3), 384–388. https://doi.org/10.1111/bju.12536 https://pubmed.ncbi.nlm.nih.gov/24612341/
#3: Lu, M., Luo, Y., Wang, Y., Yu, J., Zheng, H., & Yang, Z. (2023). Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients. BMC Urology, 23(1). https://doi.org/10.1186/s12894-023-01176-y https://pubmed.ncbi.nlm.nih.gov/36709292/
#4: Pepdjonovic, L., Tan, G. H., Huang, S., Mann, S., Frydenberg, M., Moon, D., Hanegbi, U., Landau, A., Snow, R., & Grummet, J. (2017). Zero hospital admissions for infection after 577 transperineal prostate biopsies using single-dose cephazolin prophylaxis. World Journal of Urology, 35(8), 1199–1203. https://doi.org/10.1007/s00345-016-1985-1 https://pubmed.ncbi.nlm.nih. gov/27987032/
#5: Stefanova, V., Noakes, J., Buckley, R., Flax, S., Spevack, L., Hajek, D., Tunis, A., Lai, E., Loblaw, A., Golda, N., Persaud, B., Spevack, K., Peltz, J., Deif, H., Jacobs, I., Margau, R., Raphael, S., Morton, G., Cheung, P., et al. (2019). Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability. The Journal of Urology, 201(6), 1121–1126. https://doi.org/10.1097/JU.0000000000000156 https://pubmed.ncbi.nlm.nih.gov/30835607/
#6: Huang, G.-L., Kang, C.-H., Lee, W.-C., & Chiang, P.-H. (2019). Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study. BMC Urology, 19(1), 1–8. https://doi.org/10.1186/s12894-019-0539-4 https://pubmed.ncbi.nlm.nih.gov/31660936/
#7: Honoré, A., Moen, C. A., Juliebø-Jones, P., Reisaeter, L. A. R., Gravdal, K., Chaudhry, A. A., Rawal, R., Sandøy, A., & Beisland, C. (2024). Transitioning from transrectal to transperineal prostate biopsy using a freehand cognitive approach. BJU International, 133(3), 324–331. https://doi.org/10.1111/bju.16237 https://pubmed.ncbi.nlm.nih.gov/38009392/
#8: Mian, B. M., Feustel, P. J., Aziz, A., Kaufman, R. P., Bernstein, A., Avulova, S., & Fisher, H. A. G. (2024). Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE PC Randomized Clinical Trial. The Journal of Urology, 211(2), 205–213. https://doi.org/10.1097/JU.0000000000003788 https://pubmed.ncbi.nlm.nih.gov/37976319/
#9: PanzoneJ. Byler T. Bratslavsky G. & Goldberg H. (2022). Transrectal ultrasound in prostate cancer: current utilization integration with Mpmri Hifu and other emerging applications. Cancer Management and Research 1209–1228. https://pubmed.ncbi.nlm.nih.gov/35345605/
COPYRIGHT © 2025. ALL RIGHTS RESERVED. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. ALL OTHER TRADEMARKS ARE THE PROPERTY OF THEIR RESPECTIVE OWNERS. ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANADIAN LAW. PRINTED IN USA. 2025M-3426 REV. 1
