Can a Prostate Biopsy Cause Infection?


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Can a prostate biopsy cause infection? If your doctor has scheduled a prostate biopsy for you, should you be worried about serious complications and infection? Considering the findings of a new study—and several previous ones–it’s a topic you should raise with your physician when considering your prostate biopsy recovery. Johns Hopkins researchers reveal a significant increase in the number of serious complications requiring hospitalization after men have had a prostate biopsy.

More than 1 million prostate biopsies are performed in the United States each year. Although men are typically given antibiotics before the procedure to help ward off infection, this complication is one of the challenges physicians and patients face.

According to Edward Schaeffer, MD, PhD, a Johns Hopkins urologist and oncologist and the study’s senior investigator, “the fact that infections serious enough to cause hospital admissions have been on the rise makes us think that these types of complications are occurring because of a steady increase in antimicrobial resistance rates in America.”

Can a Prostate Biopsy Cause Infection and Complications?

Along with a rise in the rate of infections following prostate biopsy, the study also revealed other complications, such as bleeding and flare-ups of underlying conditions, including breathing disorders and heart failure. Overall, the study, which will be published in the November 2011 issue of the Journal of Urology, found a 6.9% rate of hospitalization within 30 days of a prostate biopsy compared to a 2.9% rate among men who did not have a biopsy. The study looked at more than 17,400 men age 65 and older who had a prostate biopsy and compared them with 134,977 controls.

There is some good news from the study: the hospitalization rate following prostate biopsy has been dropping since 1991, so the 6.9% rate is an improvement. On the flip side, however, men hospitalized because they got a prostate biopsy-related infection had a 12-fold greater chance of dying compared with men who did not have a biopsy.

The Johns Hopkins study is not the first time the alarm over complications associated with prostate biopsy has been raised. At the 2010 American Urological Association Meeting in San Francisco, findings from six different studies regarding complications of transrectal ultrasound prostate biopsies were discussed. The presenters noted that overall, 791 of 66,811 (1.2%) men who had a prostate biopsy developed urosepsis, which can range from a urinary tract infection to a serious systemic blood infection. Most of the men required hospitalization.

The findings from these studies and from the Johns Hopkins research suggest prostate biopsies may be overused, and that they may be exposing men to deadly infections that are resistant to existing antibiotics. According to a quote in Bloomberg from Peter T. Scardino, chief of surgery at the Memorial Sloan-Kettering Cancer Center, “We’re all beginning to see more and more sepsis as a result of resistant bacteria after prostate biopsies. This is an extremely worrisome problem.”

Can a Prostate Biopsy Cause Infection from the Rectum?

The risk of infection from a prostate biopsy is related to the fact that the needles used to collect the specimens are passed through the rectum. Thus the needles can transport bacteria from the bowel into the prostate, bladder, and bloodstream. If the bacteria are resistant to the antibiotics given to the patient, infection can occur.

Men who are most susceptible to having resistant bacteria include those who have taken antibiotics in the year before undergoing a prostate biopsy, anyone who works in a hospital or lives with someone who does, and men who have visited countries where bacterial resistance is common in the community.

If you are contemplating a prostate biopsy, a discussion about potential complications is in order. H. Ballentine Carter, MD, coauthor of the Johns Hopkins study and a professor of urology and oncology, said “we believe that more needs to be done to reduce potential complications. It is important for urologists to determine if a biopsy is appropriate for an individual patient and also if the patient is at increased risk for a biopsy-related complication.”

References

Gale J. Prostate exam deaths from ‘superbugs’ spur inquiry into cancer test. Bloomberg May 5, 2011

Loeb S et al. Complications after prostate biopsy: data from SEER-Medicare. Journal of Urology 2011 Nov; 186(5): 1830-34

Nickel JC et al. Best of the AUA Annual Meeting. Rev Urol 2010 Spring-Summer; 12(2-3): e134-e146


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