Updated prostate Bx paper outlines preventive strategies
Risk assessment, directed or augmented prophylaxis among recommendations
Despite a recent decline in the number of prostate biopsies performed each year, it remains one of the most common urologic procedures in the United States (also see “Major decline in prostate Bx rates follows PSA publications"). According to a recent white paper published by the AUA and the Society of Urologic Nurses and Associates, risk assessment should be performed in all men undergoing prostate biopsy to determine their risk of complications and alternative strategies should be utilized to prevent such complications.
Lead author Michael Liss, MD, assistant professor of urology the University of Texas Health Science Center in San Antonio, and co-authors have updated the previous white paper from 2012 to include new data on the prevalence of prostate biopsy-related complications and outline the current preventive strategies. This white paper, which is meant to serve as “a more concise reference document for the more common complications,” is focused primarily on the infectious complications. The report is based on the data compiled from 119 manuscripts on this subject between January 2010 and June 2015 and was published online in the Journal of Urology (March 28, 2017).
Bleeding complications are the most prevalent complications after prostate biopsy and are reported in 10%-95% of patients. These complications include hematospermia, hematuria, and rectal bleeding. While these side effects can be troublesome and anxiety provoking for patients, these are almost always self-limited. Active intervention for hematuria or rectal bleeding, such as cauterization, hospitalization, endoscopy, etc. are required in 1%-2.5% of men.
The biopsy-related infectious complications, which are less frequent but potentially more serious, have been on the rise over the last 10 years. This is in large part due to the presence of fluoroquinolone (FQ)-resistant gram negative bacterial colonization of the rectum. The authors noted that the risk of FQ-resistance in the rectal cultures to be over 20%. They reported the rate of infectious complications to be from 0.1% to 7.0%, and the risk of sepsis from 0.3% to 3.1%.