目前，由于感染风险较低和临床显著前列腺癌（csPCa）检测效果有所提高，经阴道前列腺活检（TPB）比经直肠活检（TRB）更受欢迎。然而，有关省略抗生素预防（AP）的文献有限。此外，以往的研究中，在csPCa的定义中没有包括侵袭性筛孔生长/导管内癌（CR/IDC）。因此，我们比较了TPB不使用AP和TRB使用AP之间的感染并发症率，并比较了将CR/IDC包括在csPCa定义中的TPB和TRB之间的csPCa检测率。我们纳入了2013-2019年间被转介到Erasmus MC癌症研究所进行MRI/TRUS融合引导前列腺活检的729名男性。截至2019年，使用AP进行TRB，此后TPB不使用AP。并且，我们前瞻性地收集了并发症方面的数据。对于未曾被诊断为前列腺癌的男性，我们使用多变量逻辑回归，对于接受积极观察的男性，则使用混合逻辑回归比较前列腺活检途径之间的csPCa检测率。为了比较前列腺活检途径之间的csPCa检测率和前列腺前部和尖部病变以及并发症率之间的差异，我们使用卡方检验。总体而言，在TPB和TRB之间没有发现csPCa检测率的区别（比值比1.0，95％置信区间（CI）为0.62-1.76，p = 0.9，对于接受积极观察的男性：比值比1.05，95％-CI为0.58-1.88，p = 0.9）。虽然绝对数字较少，但在前列腺前部和尖部病变中仍然得到证实。与TRB相比，TPB降低了发热的感染并发症（1.1％ vs 5.1％，差异= 4.0％，95％-CI 1.0-7.9，p = 0.010）。TPB的csPCa检测率与TRB相同，同时由于感染并发症较少，即使省略AP，TPB仍然更受欢迎。©2023。作者（们）在Springer Nature Limited独家许可下发表。

Currently, transperineal prostate biopsy (TPB) is preferred over transrectal biopsy (TRB) because of less infectious complications and improved clinically significant prostate cancer (csPCa) detection. However, literature on omitting antibiotic prophylaxis (AP) is limited. Furthermore, previous studies did not include invasive cribriform growth/intraductal carcinoma (CR/IDC) in the definition of csPCa. Therefore, we compared the infectious complication rates between TPB without AP and TRB with AP, and we compared the csPCa detection rates between TPB and TRB including CR/IDC in the definition of csPCa.We included 729 men who were referred to Erasmus MC Cancer Institute between 2013-2019 for MRI/TRUS fusion-guided prostate biopsy. Up to 2019, TRB was performed with AP, thereafter TPB was performed without AP. Data on complications were collected prospectively. We compared csPCa detection rates between the biopsy routes using multivariable logistic regressions for men without previous PCa diagnosis and mixed logistic regression for men on active surveillance. To compare the csPCa detection rates in anterior and apical lesions, and the complications rates between the biopsy routes, we used the chi-square test.Overall, we found no difference in csPCa detection between TPB and TRB (odds ratio 1.0, 95%-confidence interval (CI) 0.62-1.76, p = 0.9; for men on active surveillance: odds ratio 1.05, 95%-CI 0.58-1.88, p = 0.9). This was confirmed in anterior and apical lesions although absolute numbers were low. TPB reduced infectious complications with fever compared to TRB (1.1% vs 5.1%, difference = 4.0%, 95%-CI 1.0-7.9, p = 0.010).TPB has no different csPCa detection rate from TRB taking CR/IDC into account. TPB is, however, preferable because of less infectious complications, even if AP is omitted.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.