Infections after prostate biopsy on the rise
NEW YORK (Reuters Health) - Serious infections after prostate biopsies appear to be on the rise in the U.S., possibly fueled by antibiotic-resistant bacteria, a new study of elderly men suggests.
More than a million prostate biopsies are done each year on Medicare patients, often to investigate suspicious results from prostate cancer screening. But the majority of those are false alarms, and some doctors worry that many men could be suffering needlessly due to screening.
Just last week, a government-funded expert panel concluded that prostate cancer screening saves few or no lives, but causes harm through treatment or further invasive testing such as biopsies.
According to the U.S. Preventive Services Task Force (USPSTF), up to one in five men will have abnormal screening results that trigger a biopsy over a decade.
In the new study, published in the Journal of Urology, 6.9 percent of men who had a prostate biopsy landed in the hospital within a month. Among a group of men who didn't get a biopsy but were of similar age, the rate was only 2.7 percent.
Still, the lead researcher on the study said it doesn't prove biopsies caused serious complications in four out of a hundred patients (the difference between the two rates).
"There is no away to confirm that this is biopsy-related," Dr. Stacy Loeb, a urologist at the NYU Langone Medical Center in New York, told Reuters Health.
Another urologist, Dr. Herbert Lepor, agreed.
"Maybe the person who goes to the doctor to have a biopsy is more inclined to see the doctor, who then sends him to the hospital to have a hip replacement or be treated for pneumonia," said Lepor, who also works at NYU but was not linked to the study.
However, the results do show an uptick in infections of the urinary system, such as prostatitis and kidney infections, in men who've had a biopsy.
About four out of 1,000 in the biopsy group were hospitalized as a result of such an infection in the month following their procedure, compared to two out of 1,000 in the comparison group.
"The rare patient, less than one percent in our study, has a serious infectious complication leading to hospitalization," said Loeb. "We think it's probably related to antibiotic resistance."
That's because doctors perform the biopsy through the rectum, possibly introducing bacteria into the prostate or blood stream.
Both doctors said they disagree with the USPSTF's new recommendation, still in draft form, against prostate-specific antigen (PSA) screening for prostate cancer.
"Young men who would benefit from early prostate cancer diagnosis should not be afraid of getting a biopsy," said Loeb. "But they should inform their physicians of any risk factors for resistant bacteria, such as recent antibiotic use or hospitalization."
According to the USPSTF, prostate biopsies cause fever, infection, bleeding or temporary urinary difficulty in about 68 men per 10,000 biopsies.
If a cancer is found, treatment such as radiation or surgery leads to common side effects such as incontinence and impotence. Yet many prostate tumors will never cause trouble if left alone, the panel cautions.
SOURCE: bit.ly/rgVfTP The Journal of Urology, online September 23, 2011.
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