Prostate Cancer

Posted: October 16, 2011 in Uncategorized
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Men who underwent prostate biopsy were more than twice as likely to be hospitalized within 30 days compared with men who did not undergo the procedure, a study of Medicare beneficiaries showed. Procedural complications, such as infection and bleeding, as well as exacerbations of comorbid conditions contributed to a hospitalization rate of 6.9% following prostate biopsy versus a 2.9% hospitalization rate for controls. Covering a 16-year period that ended in 2007, the data revealed a significant jump in the incidence of biopsy-related infection toward the end of the period, possibly a reflection of emerging multidrug-resistant organisms. Hospitalization for biopsy-related infection increased the mortality odds 12-fold, as compared with men who did not have prostate biopsies, as reported online in the Journal of Urology. "Prostate biopsy is an essential procedure for detecting prostate cancers," senior author Edward Schaeffer, MD, PhD, of Johns Hopkins, said in a statement. "Coupled with appropriate screening, prostate biopsies save lives. However, it is important for men to be aware of the possible risks of prostate biopsies, which are often described as simple outpatient procedures."
The results emphasize the need for careful evaluation to ensure a biopsy is necessary and to take appropriate precautions to reduce the risk of infection and other complications, he added. Medicare beneficiaries have more than one million prostate biopsies each year. The odds of a follow-up biopsy after a negative initial biopsy are 12% at one year and 38% at five years, Schaeffer, first author Stacy Loeb, MD, also of Johns Hopkins, and co-authors wrote in their introduction. Because prostate needle biopsy is performed with transrectal ultrasound guidance, the procedure may introduce rectal bacteria into the prostate, creating a potential for infection. To decrease the risk of infection, periprocedural antibiotic prophylaxis has become routine, which has the potential to contribute to emerging antibacterial resistance in the U.S., the authors continued. Severe infection can lead to hospitalization, as can certain other potential complications of prostate biopsy, such as hematuria, hematochezia, and urinary retention.The rate of prostate biopsy-related hospitalization in the Medicare population has not been documented previously. To inform on the issue, Loeb and colleagues analyzed a 5% random sample of Medicare-linked data from the NCI's Surveillance, Epidemiology, and End Results program.
The analysis included 17,472 men who underwent prostate biopsy from 1991 to 2007 and a random-sample control group of men who did not have the procedure. The biopsy group was slightly older (median age 73 versus 72.4), healthier (by Charlson comorbidity index), and more likely to be white. The biopsies led to prostate cancer diagnoses in 2,992 men. The authors found that 1,209 men in the biopsy group were hospitalized within 30 days of the procedure and for every year of the study period, hospitalization after prostate biopsy occurred more often than in the control group. Infection was the primary diagnosis in 0.38% of the biopsy group and 0.19% of the control group . Noninfectious complications also led to hospitalization significantly more often after prostate biopsy (0.30%) than in the control group. Infectious complications leading to hospitalization rose steadily from 2000 to the end of the study period, exceeding 1% in the biopsy group by 2007.
In a multivariate analysis, prostate biopsy was associated with a 30-day hospitalization odds ratio of 2.65. The odds of hospitalization within 30 days were significantly increased for infectious (2.26) and noninfectious (8.48) complications. Exclusion of men who had prostate cancer diagnoses at or after biopsy yielded an overall odds ratio for hospitalization of 2.32, 2.99 for infectious complications, and 12.71 for noninfectious complications. "This suggests that prostate cancer treatment or treatment-related complications were not responsible for the increased risks of hospitalization and biopsy-related complications observed," the authors wrote. The hospitalization rate after prostate biopsy was higher than previously suggested, they continued. Studies are needed to confirm the findings and to examine the complication and hospitalization rates after prostate biopsy in younger men. "There is a nontrival risk of serious complications after prostate biopsy," the authors wrote in conclusion. "These findings highlight the importance of careful patient selection and counseling regarding prostate biopsy," they added. Limitations of the study included: lack of individual data on indications for biopsy, number of core specimens taken, cultures, antimicrobial prophylaxis, and physician volume of biopsies; possibility of misattribution of complications to the procedure; absence of data on indications for hospitalization which could vary by institution and outpatient complications. [Source: MedPage Today Charles Bankhead article 22 Sep 2011

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