Editing Prostate Biopsy (section)

==== Transperineal ====

* Risk of infection is decreased compared to transrectal since trajectory avoids rectum
* '''<span style="color:#ff00ff">NORAPP Trial (2022)</span>[https://pubmed.ncbi.nlm.nih.gov/35839791/]'''
** Population: 555 patients referred for prostate biopsies
*** Excluded patients at high-risk (clinical suspicion of urinary tract infection together with a positive urine dipstick for leukocytes and nitrate, recurring or recent urinary tract infection (<1 month), indwelling urinary catheter, immunodeficiencies, high risk of infective endocarditis, or history of thromboembolic disease) of post-biopsy infection
*** All patients with a positive MRI underwent two to four biopsies per target. Systematic biopsies were done as an addition to target biopsies in biopsy naive patients and in all patients with a negative MRI.
** Randomized (open-label) to antibiotics (cefuroxime 1.5g IV or IM 30 minutes before biopsy) vs. no antibiotics
** Outcomes:
*** Primary: difference in the rate of urosepsis or urinary tract infections requiring hospitalisation up to 2 months after biopsy 
*** Secondary: difference in the rate of urinary tract infections not requiring hospitalisation by 2 months
** Results:
*** Primary outcome: no significant different in rate of urosepsis or UTI requiring hospitalisation up to 2 months after biopsy (0% antibiotics vs. 0% no antibiotics)
*** Secondary outcome: no significant difference in rate of UTI not requiring hospitalisation by 2 months (0.4% antibiotics vs. 1.1% no antibiotics)
**** NNT with antibiotic prophylaxis to avoid one UTI not requiring hospitalisation: 137
** '''Interpretation: In patients undergoing transperineal biopsy, antibiotics do not significantly reduce the risk of infections'''
** Jacewicz, Maciej, et al. "[https://pubmed.ncbi.nlm.nih.gov/35839791/ Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial.]" ''The Lancet Infectious Diseases'' (2022).