Background: The best method to confirm prostate cancer diagnosis is by performing a transrectal ultrasound guided biopsy. This procedure does not come without risks as international reports suggest that frequency of hospitalization after biopsy are increasing. This study aimed to estimate incidence and risk factors for hospitalization after prostate biopsy in Iceland. Methods: Every patient in Iceland who had undergone a prostate biopsy during the years 2013-2017 was included in the study. Primary outcome measure was hospitalization within fifteen days from the biopsy. We also studied the type of infectious agents and resistance to ciprofloxacin or trimethoprim. Multivariable logistic regression model was used to identify risk factors for hospitalization. Results: Of 2076 men who had prostate biopsies 59 (2.8%) were hospitalized within fifteen days. Of these men 45 (76.3%) were hospitalized because of infection, 6 (10.2%) were hospitalized because of bleeding and 8 (13.5%) were hospitalized for other reasons. Risk factor for hospitalization was higher age (OR 1.06 p < 0.001). An antibiotic prescription within 6 months of biopsy was a protecting factor (OR 0.57 p = 0.04). E.coli was the most common infectious agent (73.3%). Pseudomonas, Staphylococcus and Streptococcus dysgalactiae where other agents. Of those admitted to hospital with infection 57.1% of the agents were resistant to ciprofloxacin and 54% to trimethoprim. 31.4% of the infectious agents were resistant to both antibiotics. Conclusions: Despite the invasive nature of the procedure and increasing bacterial antibiotic resistance the rate of hospitalization was relatively low (2.8%). Antibiotic resistance to ciprofloxacin or trimethoprim might prompt a change in common prophylactic practice and a need for new clinical practice guidelines in Iceland.