Safety of transrectal ultrasound–guided prostate biopsy in a resource-limited setting: A review of 3561 cases

Background: Prostate cancer is a leading cause of cancer-related deaths in men globally, with men of African origin experiencing higher incidence and mortality. Transrectal ultrasound–guided prostate biopsy remains a standard tool for early diagnosis but is associated with complications, particularly infections. This study evaluates the incidence, management and outcomes of complications requiring hospitalisation. Methods: A retrospective analysis of a prospectively compiled database of 3561 patients who underwent transrectal ultrasound–guided prostate biopsy at Korle Bu Teaching Hospital between 2017 and 2024 was conducted. Severe complications, defined as those requiring hospitalisation, were assessed. Prophylactic antibiotics included oral levofloxacin and a single intravenous dose of gentamicin. Data on demographics, clinical parameters and outcomes were analysed using descriptive and inferential statistics. Results: Severe complications occurred in 1.34% of patients, including febrile infections (0.54%), urinary retention (0.54%) and major bleeding (0.26%). One mortality (0.03%) due to sepsis was recorded. Patients with prostate-specific antigen >100 ng/mL and those aged >80 years exhibited higher complication rates, although these were not statistically significant predictors. The dual-antibiotic prophylaxis regimen effectively minimised infectious complications despite high fluoroquinolone resistance. Conclusions: This large series shows that transrectal ultrasound-guided prostate biopsy remains safe under a dual-antibiotic protocol. Patients and policymakers can use these findings during discussion of the risk and benefits of early detection strategies for prostate cancer.