A Comprehensive Systematic Review of Comparison of Antibiotic Prophylaxis in Prostate Cancer Patient Biopsy Cases
Abstract
Introduction: Prostate biopsy is a crucial diagnostic procedure for prostate cancer but carries a risk of infectious complications, including urinary tract infections, bacteremia, and sepsis. The rising global prevalence of antibiotic resistance, particularly to fluoroquinolones, has complicated traditional empirical prophylaxis, necessitating a thorough reevaluation of optimal prevention strategies (Pilatz et al., 2020). Methods: This comprehensive systematic review synthesized evidence from 80 sources, including randomized controlled trials (RCTs), meta-analyses, and cohort studies. The review compared antibiotic prophylaxis versus no prophylaxis, different antibiotic regimens (e.g., fosfomycin vs. fluoroquinolones), prophylaxis durations, empirical versus targeted approaches, augmented prophylaxis, and the impact of biopsy approach (transrectal vs. transperineal). Data on infection outcomes, resistance patterns, and non-infectious complications were extracted and analyzed. Results: Antibiotic prophylaxis significantly reduces infectious complications for transrectal prostate biopsy compared to no prophylaxis (RR 0.56) (Pilatz et al., 2020). For transperineal biopsy, evidence shows no significant benefit of prophylaxis, with pooled infection rates of 0.50% with vs. 0.37% without antibiotics (Castellani et al., 2021; Wolff et al., 2024). Fosfomycin demonstrated superior or equivalent efficacy to fluoroquinolones, particularly in reducing febrile UTIs (Freitas & Moreira,…
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