Systematic Review and Meta-Analysis on the Timing and Severity of Prostate Biopsy Infections

Background: Approximately 3 million prostate biopsies are performed annually worldwide with the majority performed through a transrectal approach. Review papers cite a 5% to 7% risk for an infectious complication; however, the majority of the evidence is retrospective, and the timing of these infections is poorly understood. We conducted a systematic review and meta-analysis to examine the timing and severity of infections after prostate biopsy. Methods: This study followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the protocol was registered in PROSPERO (CRD420245074130). PubMed, Ovid, and Cochrane Central Controlled Register of Trials were searched for peer-reviewed randomized control trials. Abstracts and full-text screening were performed using Covidence Systematic Review Management. Data including number of participants, biopsy route, antibiotic prophylaxis, and infection rate, severity, and method of measurement were extracted. A χ 2 test compared the proportion of infections or hospitalizations across studies. A meta-effects regression with random effects was performed to meta-analyze the timing and severity of infections after prostate biopsy. Bias was assessed using the Cochrane Risk of Bias 2 form. All analyses were performed in R (Version 4.1.0). Results: Fifty-five papers met inclusion criteria. The total patients were 24,259, with 21,927 transrectal and 2332 transperineal biopsies. Infections were reported in 4% of patients, with 0.8% requiring hospitalization. Infections were laboratory confirmed in 39 (71%) of studies, and hospitalization rates were documented in 37 (67%) of studies. The meta-regression of both infection and hospitalization rates by time point showed significant heterogeneity between studies. Compared with the referent 3-day group, infection rate was significantly lower at 7 and 30 days, with an estimated 3.2% reduction in infection risk for the 7-day group. With 3 days as a reference, time point was not significantly associated with hospitalization rates at 7 days. Conclusions: Our meta-analysis found that infections were significantly more likely to occur within 3 days compared with 7 or 30 days of biopsy, and hospitalization rates followed a similar, albeit nonsignificant trend. Uniformly measuring at 7 days postbiopsy may provide the most reliable estimate of infection rates. Consistent documentation of infectious complications may help reliably inform future guidelines.