Complications After Prostate Biopsies Are Rising
A recent upsurge in infectious complications is worrisome.
The rate of complications following prostate biopsy is relevant to the balance of benefits and harms from prostate cancer screening. Johns Hopkins urologists determined 30-day hospitalization rates after prostate biopsy in a random national sample of 17,000 Medicare participants who underwent biopsy procedures between 1991 and 2007.
The 30-day hospitalization rate of 6.9% was significantly higher than the 2.9% rate among 135,000 randomly selected controls of similar age (for controls, a 30-day period was selected randomly). Exclusion of men with diagnosed prostate cancer — who might have been hospitalized for cancer treatment after positive biopsies — yielded a similarly elevated relative risk for hospitalization. Men in the biopsy group were at significantly higher risk than controls for hospitalizations with diagnostic codes for urinary or prostatic infection (0.4% vs. 0.2%) and for noninfectious complications such as hematuria or urinary retention (0.30% vs. 0.04%). The rate of hospitalizations for infectious complications rose significantly over time: It was consistently lower than 0.5% before the year 2000, but, more recently, it's been between 0.5% and 1.0%.
Comment: The authors conclude that "there is a nontrivial risk of serious complications after prostate biopsy." These figures underestimate the total complication rates, given that some patients are treated in outpatient or emergency department settings. The authors also express concern that quinolone resistance might account for the temporal trend of increasing infection rates. Interestingly, a recent Canadian study also documented that the incidence of post-biopsy hospitalization for infection increased strikingly between 1996 and 2005 (J Urol 2010; 183:963).
— Allan S. Brett, MD
Published in Journal Watch General Medicine November 10, 2011
The 30-day hospitalization rate of 6.9% was significantly higher than the 2.9% rate among 135,000 randomly selected controls of similar age (for controls, a 30-day period was selected randomly). Exclusion of men with diagnosed prostate cancer — who might have been hospitalized for cancer treatment after positive biopsies — yielded a similarly elevated relative risk for hospitalization. Men in the biopsy group were at significantly higher risk than controls for hospitalizations with diagnostic codes for urinary or prostatic infection (0.4% vs. 0.2%) and for noninfectious complications such as hematuria or urinary retention (0.30% vs. 0.04%). The rate of hospitalizations for infectious complications rose significantly over time: It was consistently lower than 0.5% before the year 2000, but, more recently, it's been between 0.5% and 1.0%.
Comment: The authors conclude that "there is a nontrivial risk of serious complications after prostate biopsy." These figures underestimate the total complication rates, given that some patients are treated in outpatient or emergency department settings. The authors also express concern that quinolone resistance might account for the temporal trend of increasing infection rates. Interestingly, a recent Canadian study also documented that the incidence of post-biopsy hospitalization for infection increased strikingly between 1996 and 2005 (J Urol 2010; 183:963).
— Allan S. Brett, MD
Published in Journal Watch General Medicine November 10, 2011
Citation(s):
Loeb S et al. Complications after prostate biopsy: Data from SEER-Medicare. J Urol 2011 Nov; 186:1830. (http://dx.doi.org/10.1016/j.
Medline abstract (Free)
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