Swedish Study Reports Increasing Rates of Severe Infection Requiring Hospitalization After Prostate Biopsy
Transrectal ultrasound guided biopsy is the standard for detecting prostate cancer, but international reports have suggested that the risks associated with the procedure are increasing. In a new nationwide population-based study reported in The Journal of Urology, Swedish researchers found that 6% of men filled a prescription for antibiotics for a urinary tract infection within 30 days after having a prostate biopsy, with a twofold increase in hospital admissions over 5 years.
Earlier studies reported serious adverse events after prostate biopsy including febrile urinary tract infection and urosepsis in 1% to 4% of men, despite the use of prophylactic antibiotics. There have also been reports that chronic conditions such as diabetes, benign prostatic hyperplasia, and a history of urinary tract infection increase the risk of infections.
Study Details
To estimate the incidence of infection after prostate biopsy and assess risk factors for infection and 90-day mortality in Sweden, researchers looked at records of more than 51,000 men registered in the Swedish Prostate Cancer database who underwent transrectal ultrasound guided prostate biopsy between 2006 and 2011. They also compiled data from the National Prostate Cancer Register (NPCR) of Sweden, which captures more than 96% of all newly diagnosed prostate cancers in the country.
“We aimed to estimate the frequency and severity of infectious complications in men diagnosed with prostate cancer after prostate biopsy by examining how many men filled prescriptions for antibiotics related to urinary tract infections, rates of hospitalization within 30 days, and death due to infection,” said lead investigator Karl-Johan Lundström, MD, of the Department of Surgical and Perioperative Sciences, Urology, Andrology, Umeå University, Östersund, Sweden. “We also capitalized upon the unique nationwide cross-linked health care databases in Sweden to perform a more comprehensive evaluation of potential risk factors for infectious complications,” he added.
Results
Of the 6% of men who filled a prescription for urinary tract antibiotics within 30 days of biopsy, 54% filled the prescription in the first week after biopsy. One percent of men were hospitalized with a urinary tract infection.
Between 2006 and 2011 the number of men obtaining an antibiotic prescription after biopsy decreased, whereas the number who were hospitalized increased. No significant increase in 90-day mortality was observed, however.
The strongest risk factors for an antibiotic prescription were multiple comorbidities, particularly diabetes, and prior infection. Overall, approximately 2% of the men had a urinary tract infection during the 6 months before biopsy.
“Our data show that severe infections with hospitalization after prostate biopsy are increasing in Sweden. The rate of hospital admission increased twofold during this 5-year period. However, the risk of dying of an infection after prostate biopsy is very low,” observed Dr. Lundström. “The risk of postbiopsy infection is highest among men with a history of urinary tract infections and those with significant comorbidities. The increasing risk of hospitalization is concerning and highlights the importance of carefully evaluating the indications for biopsy especially in men at increased risk of infection,” he concluded.
Dr. Lundström is the corresponding author for The Journal of Urology article.
The study was supported by The Swedish Research Council, The Swedish Cancer Foundation, Västerbotten County Council, Lion’s Cancer Research Foundation at Umeå University, and Percy Falk Foundation. Stacy Loeb, MD, reported a financial interest and/or other relationship with Sanofi.
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