There has been increased discussion in the past couple of years related to the risk of infection in men undergoing prostate biopsy after initial testing for risk of prostate cancer (based on results of PSA test data and/or a digital rectal examination). Studies based on data from the United States and Canada have previously reported a rising number of hospitalizations for infectious complications after prostate biopsy.
Loeb et al. have now published an analysis of data on infectious complications and hospitalizations after prostate biopsy among patients enrolled in the the Dutch component (Rotterdam section) of the European Randomized Study of Screening for Prostate Cancer (ERSPC).
Between 1993 and 2011, a total of 10,474 prostate biopsies were carried out among patients in the Rotterdam section of the ERSPC. All patients in this study who were given a prostate biopsy also received prophylactic antibiotic therapy prior to their biopsy. From 1993 to 2007, the recommended antibiotic was trimethoprim-sulfamethoxazole; in 2008, the antibiotic was changed to ciprofloxacin.
All patients in the Rotterdam section of the study were asked to complete a questionnaire 2 weeks after their biopsy that included questions about fever (“febrile complications” to be strictly accurate) and hospital admissions.
Here are the results reported by Loeb and her colleagues:
- Fevers were reported by 392 patients in 9,241 questionnaires received (4.2 percent).
- Hospital admissions were reported by 78 patients in 9,198 questionnaires received (0.8 percent).
- Most fevers were effectively managed on an outpatient basis.
- 63/78 hospital admissions (81 percent) were for infection.
- Blood culture results from 34/56 patients hospitalized for infection were positive and Escherichia coli was the organism most commonly identified as the cause of infection.
- Men with prostate enlargement and diabetes appeared to be at highest risk for fever after a prostate biopsy.
- Later year of biopsy was the only factor significantly associated with an increased risk of hospital admission.
Clearly, in this analysis, the risk of hospitalization after a prostate biopsy was low overall (at < 1 percent), and most infectious complications could be effectively dealt with on an outpatient basis. However, it is notable that, “Consistent with prior international reports, the frequency of hospital admissions after [prostate biopsy] significantly increased over time.” This finding is consistent with the idea that there is an increased incidence of biopsy-induced infections caused by bacteria that are resistant to commonly used antibiotics like trimethoprim-sulfamethoxazole and ciprofloxacin.
The authors state their opinion that, “the absolute frequency of hospital admissions related to [prosate biopsy] was low” in this study “and should not dissuade healthy men who would benefit from early prostate cancer diagnosis from undergoing biopsy when clinically indicated.”