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Most prostate biopsies are done transrectally, but one downside of this approach is infection caused by seeding of the prostate with bacteria that colonize the rectum. In recent years, a transperineal approach — through cleaned perineal skin rather than through rectal mucosa — has been adopted by some urologists.
This U.S. multicenter randomized trial involved 742 men with elevated prostate-specific antigen (PSA) levels or palpable prostate abnormalities who were scheduled for prostate biopsy under local anesthesia; patients underwent either transrectal biopsy (with antibiotic prophylaxis) or transperineal biopsy (without antibiotic prophylaxis). The primary outcome, infection after biopsy, occurred in fewer patients in the transperineal gro…