Risk for complications after prostate biopsy — and consequent revisions to best practice

A new article in Urology (the Gold journal) addresses risk for complications after prostate biopsy in a recent series of > 2,500 biopsies conducted by physicians at a large urology practice in southern California — and what they did as a consequence.

The article by Gaylis et al. (along with a “Beyond the Abstract” supplement on the Urology Today web site) describes how the authors used two separate techniques to seek out information about post-biopsy complications using data from patient’s electronic medical records (EMR data) combined with a manual chart review (intended to ensure that there was a clear likelihood that a complication was actually associated with a preceding biopsy)  and by actually distributing a questionnaire to the relevant patients. “Serious” complications associated with a prostate biopsy were defined as those leading to “an unintended but related hospital, Emergency Department (ED), Urgent Care (UC) or doctor’s office visit within 30 days.”

Here are the core study findings, which come from the Integrated Urology Group Practice, Genesis Healthcare Partners, in San Diego, CA:

  • A total of 2,588 prostate biopsies were conducted over a 30-month period.
  • The numbers of patients having a serious complication within 30 days of their biopsy were
    • Based on the EMR data
      • 69 patients (2.7 percent) in total
      • 30 patients (1.16 percent) who required hospitalization
    • Based on the patient survey data
      • 4.3 percent of respondents in total
      • 1.1 percent of respondents who required hospitalization
  • 56 percent of patients who had a complication were effectively managed outside of any hospital.
  • 65 percent of complications were a consequence of infections.
  • Non-infectious complications (35 percent) included
    • Urine retention
    • Severe and/or persistent gross hematuria (blood in the urione)
    • Rectal bleeding that required a blood transfusion
  • There was no difference in infectious complications in men undergoing a repeat biopsy compared to those undergoing their first biopsy.

Based on these data, this group of urologists implemented a new set of best practices in order to minimize risk for complications associated with prostate biopsy. The key components of this set of best practices include:

  • A “time out” between recognition of the need for a prostate biopsy and the performance of that biopsy
  • Conduct of pre-biopsy, prophylactic antibiotic therapy using either
    • A tailored antibiotic regimen based on a pre-biopsy rectal culture or
    • Dual antibiotic therapy that includes a parental antibiotic such as gentamicin or ceftriaxone

This form of prophylactic antibiotic therapy has previously been reported (by the MUSIC group in Michigan) to reduce risk for hospitalization as a consequence of sepsis by 53 percent.

The “New” Prostate Cancer InfoLink is pleased to see this focus by another large community urology practice on minimization of risk for complications of prostate biopsy. However. we also think that this type of pre-biopsy time out and prophylactic antibiotic therapy should now be standard practice that precedes all forms of prostate biopsy.

2 Responses

  1. Excellent post, thank you!

  2. Reassuring news yet a cumulative impact/morbidity on the prostate and surrounding tissue is needed.

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