Prostate biopsy complications rising with a high rate of post-procedure hospitalizations

Prostate biopsy was associated with a 6.9% hospitalization rate within 30 days, compared to a 2.9% hospitalization rate among a control group of men who did not have a biopsy, researchers found.

Also, the study found a significant rise in complications, such as bleeding and infection, as well as flare-ups of underlying medical conditions, such as heart failure or breathing disorders, the study found, And while mortality rates in men undergoing prostate biopsies did not increase, those hospitalized with infections had a 12-fold higher risk of death compared to men who did not have a biopsy.

Johns Hopkins researchers published their results online Sept. 23 at The Journal of Urology.

The study examined the frequency of biopsy-related complications that required hospitalization in more than 17,400 Medicare beneficiaries from 1991 to 2007, as identified by carrier or outpatient claims, compared to a cohort of 134,977 men who did not undergo a biopsy.

The 30-day hospitalization rate was 6.9% (1,209 men) within 30 days of prostate biopsy, which was substantially higher than the 2.7% in the control population. Infectious complications were the primary diagnosis in 67 biopsied patients (0.38%) compared to 257 controls (0.19%; P<0.0001). Noninfectious biopsy-related complications were also significantly more frequent in the biopsy than in the control group (53 or 0.30% vs. 53 or 0.04%; P<0.0001). Compared to controls, biopsy was associated with a significantly greater risk of hospitalization for infectious (odds ratio [OR], 2.26; 95% CI, 1.71 to 2.99; P<0.0001) and noninfectious (OR, 8.48; 95% CI, 5.68 to 12.64; P<0.0001) complications.

After adjustment for variables, biopsy was associated with a 2.65-fold (95% CI, 2.47 to 2.84; P<0.0001) increased risk of hospitalization within 30 days compared to the control population.

Men hospitalized for infections were at increased risk for death within 30 days compared to those who weren't (OR, 12.02; 95%, CI, 8.59 to 16.80; P<0.0001).

There was also a steady rise in the rate of serious infection-related complications, researchers reported. In 1991, fewer than 0.5% of men were admitted to the hospital because of an infection following a prostate biopsy. In 2000, rates of infection-related complications began to increase, reaching more than 1.2% in 2007.

A likely explanation for the increase in infectious complications is increasing antimicrobial resistance, researchers wrote. Fluoroquinolones are the prophylaxis of choice in the procedure, but resistance to the drug class has increased in the last decade.

“We could not examine prophylactic antibiotic use in this study,” the authors wrote. “Regardless, the increasing number of serious infectious complications during the study interval highlights the need to reevaluate the optimal prophylactic regimen for prostate biopsy and other invasive procedures.”

The researchers emphasize that their results act as a warning for physicians to carefully weigh the risks and benefits of biopsy and to discuss them with patients, as well as strictly adhere to medical guidelines about screening and take all precautions to prevent infections and other complications.

“If similar results were found in a randomized trial, we estimated that 1 additional hospitalization would occur for each 24 biopsies performed,” they wrote. “These results suggest the importance of better patient selection for prostate biopsy and the identification of those at highest risk for complications.”