Risk for 120-day prostate biopsy-specific mortality — redux

Once upon a time (not so very long ago) Boniol et al. suggested that the 120-day mortality rate associated with biopsies for risk of prostate cancer might be as high as 1.3 percent. This caused something of a furore.

In a new paper by Canat et al. — based on data from biopies carried out exclusively in Lyon, France, between 2000 and 2011 — the authors suggest that the 120-day post-biopsy-specific mortality rate is only 0.02 percent. This is precisely 10 times lower that the rate initially suggested by Gallina et al. in 2008 (which was 2 deaths per 1,000 biopsies or 0.2 percent).

According to Canat et al.:

  • 8,804 men had 11,816 biopsy procedures in the Lyon public hospitals (hospices civils) between 2000 and 2008.
  • 42 deaths occurred within 120 days after each of the 11,816 procedures (a mortality rate of 0.36 percent).
  • Of these 42 deaths,
    • 9 were lost to follow-up (so we don’t have a clue why they happened).
    • 3 had no identifiable cause of death (so we don’t have a clue why they happened).
    • 28 had “an intercurrent event” that ruled out prostate cancer as a potential cause of death.
    • Only 2 deaths could be specifically associated with a prostate biopsy.

The authors then state that they were able to identify “at most 2 deaths possibly related to prostate biopsy over 11,816 procedures” (0.02 percent).  They therefore conclude that:

prostate biopsies can be lethal but this rare outcome should not be considered as an argument against prostate screening given the circumstances in which it occurs.

There is, of course, a small problem with their assessment of these data. They haven’t got a clue why 12 of their 42 patients died. It is, in fact, perfectly possible that all 12 died of infection or other consequences of a prostate biopsy. That would take the biopsy mortality rate to 14/11,816 procedures or 0.12 percent.

Then there is another problem. This is a highly selected population of at risk patients. The population of Lyon from 2000 to 2008 was about 450,000. If we assume that only 20 percent of that population were males of an age to be at meaningful risk for prostate cancer (and even that estimate may be high) then we are looking at a pretty small risk group.

The “New” Prostate Cancer InfoLink thinks that if we want to get an accurate understanding of the real risk for prostate biopsy-related mortality, we are going to need to get data from a larger and less selective database; the Swedish national databases may offer such an opportunity. We are clear in our minds that the number suggested by Boniol et al. may be high. However, we are just as clear that the 0.02 percent risk suggested by Canat et al. may be overly optimistic (especially in health systems where prostate biopsies are executed in a wide variety of practice settings, like the USA).

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