Prostate Biopsy Complication Rates Increasing

Urologic complications requiring hospital admission grew by, largely because of infections.
Urologic complications requiring hospital admission grew by, largely because of infections.

Researchers in England have documented an increase in the rate of hospitalizations for complications following transrectal ultrasound (TRUS)-guided prostate biopsy, according to a new report.

Eleni Anastasiadis, MBChB, of the Royal College of Surgeons of England, and colleagues conducted a population-based study of 198,361 men diagnosed with prostate cancer (PCa) from 2000 to 2008. Of these, 69% were aged 65 to 84 years. The investigators considered complications to have occurred if patients had been admitted to a hospital as a result of urologic causes, including urinary tract infection (UTI)/sepsis, hematuria, and urinary retention within 30 days of biopsy.

Overall, the 30-day rate of complications resulting in hospital admission was 3.7% (1.1% for UTI/sepsis, 1.4% for hematuria, and 1.3% for urinary retention). The overall urologic complication rate increased over time, from 3.6% in 2000 to 3.9% in 2008. In adjusted analyses, patients undergoing TRUS-guided biopsy in 2008 had a 20% increased odds of urologic complications overall and 72% increased odds of complications due to UTI/sepsis compared with those undergoing biopsy in 2000, Dr. Anastasiadis' team reported online ahead of print in International Journal of Urology.

Additionally, the study showed that age and comorbid conditions are the 2 most important risk factors for post-biopsy complications. Patients aged 85 years and older had 3.8 times greater odds of complications than those younger than 55 years. Patients with 3 or more comorbidities had 3.5 times greater odds than those with no comorbidities.

The authors suggested some approaches to reduce the likelihood of complications, such as being more selective when deciding which men require a TRUS-guided biopsy. Nomograms and predictive models, new biomarkers, PSA derivatives, and multiparametric magnetic resonance imaging can help clinicians in selecting for biopsy only patients at higher risk of PCa, they noted. Another approach might be the use of routine rectal swabs to guide prophylactic antibiotics and to characterize antimicrobial resistance rates.

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