Haemorrhagic risk of transperineal ultrasound‐guided prostate biopsy performed under continued antithrombotic therapy

Objectives This study aims to evaluate the safety of transperineal prostate biopsy performed with continued antiplatelet and anticoagulant therapies under caudal anaesthesia. Patients and Methods A total of 620 consecutive patients who underwent transperineal ultrasound‐guided prostate biopsy at a tertiary care centre in Japan from March 2023 to June 2025 were retrospectively analysed. Antithrombotic agents were continued according to institutional policy, and all procedures were performed under caudal anaesthesia. Patients were categorised into a no‐antithrombotic therapy group (NA group, n = 474) and an antithrombotic therapy group (AP/AC group, n = 146). The primary endpoint was any Clavien–Dindo grade I or higher haemorrhagic complications. Univariate and multivariate logistic regression analyses were conducted. Results Haemorrhagic events occurred in 8.9% and 11.7% of patients in the NA and AP/AC groups, respectively ( p = 0.33). Clinically significant haemorrhage (Clavien–Dindo grade II or higher) was rare (1.1% vs. 2.1%), and only one grade III event occurred in the AP/AC group. None of the patients required blood transfusion, and no sacral hematomas, neurological deficits or thromboembolic events were observed. Multivariate analysis adjusted for prostate‐specific antigen level, platelet count, prostate volume and number of biopsy cores revealed that antithrombotic therapy was not independently associated with haemorrhagic complications (odds ratio: 1.14; 95% confidence interval: 0.60–2.08). Conclusion Continuation of antiplatelet or anticoagulant therapy during transperineal prostate biopsy under caudal anaesthesia was not associated with a clear increase in clinically relevant haemorrhagic complications, and no anaesthesia‐related complications were observed.