We have been doing around 100 TRUS-guided prostate biopsies per annum in our clinical practice. About 5% of these patients develop complications (unpublished data) despite being given intravenous, a third-generation cephalosporin, an aminoglycoside, and oral Cifran TZ as a department policy. Of the 5% morbidity, 2% develop febrile UTI, which requires step-up of antibiotics.

This certainly isn’t a “normal” side effect of anything! I suggest you call your primary care doctor (not the urologist). It could be something to do with the drugs you were given in hospital — but it still sounds most odd.

Can anybody please tell me if they have suffered the same complication I am following a TRUS-guided biopsy (prostate) done last week. I unfortunately had my procedure turn septic and spent 2 days in the ICU and 4 days in a ward bed before returning home 2 days ago from hospital. While I am getting my strength back slowly, my concern is that I am staggering about like a drunk due to the room spinning when I get out of bed. Is this a normal side effect of all the drugs or have I got other problems? Will appreciate any relevent comments.

Kindly,

Martin (Australia)

Some thoughts on the above. I do several hundred biopsies a year and have done so for over 20 years. The hospital rate mentioned in the study is unusually high. I think I have admitted someone after a biopsy maybe five times in that span of time. Most go home the next day. The reason is usually bleeding or a bacteremia. It must have to do with the system in Canada as suggested.

I know the “lawyer” remark was done rhetorically but you must know that urologists don’t consult lawyers about medical things.

JM

I think there’s a much simpler answer that that. The Canadians have a nationalized, government-funded health system. Urologists in Canada have no financial motivation to “go looking” for prostate cancer. By comparison, in the USA, since the widespread acceptance of the PSA test, “everyone” with a PSA over 4 ng/ml could be pretty sure they’d get a biopsy, regardless of the probability that that they had prostatitis or BPH. Urologists in the US get paid for each procedure they do — and their lawyers would tell them it would be “prudent” to carry out a biopsy if there was any possibility of cancer being present.

The highest percentage I can recall seeing in US studies is about 35% so:

1. Do the Canadians use a different set of criteria for triggering a biopsy — and if so, does the pattern for prostate cancer diagnosed differ from the US? For example is the number of late stage diagnoses greater than the US?

2. Do the Canadians use a different set of criteria for defining PCa — for example do they still define a Gleason score of 2 + 2 as “cancer” where this wouldn’t be the case in the US?