Bx-related complications influence decision-making

Author(s):

Men who experience a prostate biopsy-related complication are more likely to seek active treatment for clinically localized prostate cancer than those who do not experience a complication, according to findings from a review of the Surveillance, Epidemiology, and End Results Medicare linked database.

Boston-Men who experience a prostate biopsy-related complication are more likely to seek active treatment for clinically localized prostate cancer than those who do not experience a complication, according to findings from a review of the Surveillance, Epidemiology, and End Results Medicare linked database.

The odds of choosing active surveillance was reduced by 17% among men who had a complication after transrectal prostate biopsy compared with the reference group (no complication after biopsy), said first author Melanie Adamsky, MD, at the AUA annual meeting in Boston.

Data suggest that experiencing a biopsy-related complication does not increase the risk of complications with future biopsies, nor do men with biopsy-associated complications have worse oncologic outcomes, said Dr. Adamsky, urology resident at the University of Chicago.

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“Our findings underscore the importance of counseling patients about the relative safety of active surveillance, even among men who’ve experienced complications after biopsy,” added Dr. Adamsky, who worked on the study with Brian T. Helfand, MD, PhD, and co-authors.

Her group looked at patients diagnosed with low-risk or low-volume, intermediate-risk prostate cancer and whether experiencing a complication upon a diagnostic prostate biopsy influenced their treatment decision. They identified 8,932 men with Gleason 6, clinical stage I or Gleason 3+4=7, clinical stage I prostate cancer from the SEER-Medicare linked database between 2009 and 2011. The men were assessed for adverse events or complications coded within 30 days of biopsy, including infectious complications (kidney infection, urinary tract infection, prostatitis, cystitis, sepsis/bacteremia, endocarditis, hypertension, and postoperative infection) and noninfectious complications (gastrointestinal hemorrhage, hematuria, acute post-hemorrhagic anemia, and urinary symptoms or retention).

About 2% of men experienced infectious complications and 15% had noninfectious complications after their biopsy, said Dr. Adamsky.

The outcome of interest was treatment decision. Active surveillance was defined as absence of treatment within 1 year of diagnosis and one or more biopsies within 2 years of diagnosis. Active treatment was defined as prostatectomy, radiation, cryotherapy, or androgen deprivation therapy as primary therapy.

Next: Complication type affects decision

Complication type affects decision

On multivariate logistic regression analysis, experiencing a complication was found to reduce the odds that a man would pursue active surveillance, with an odds ratio (OR) of 0.83 (p=.049).

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“When we broke it down further by type of complication, it was the noninfectious complication that seems to account for this finding,” Dr. Adamsky said. The OR of pursuing active surveillance after a noninfectious complication was 0.82 (p=.0472) compared with 0.93 (p=.7406) after an infectious complication.

The group’s hypothesis was that men who experienced a complication “are likely risk averse, they’re more anxious, although the other side of this is that it may be physician-driven,” she said. “A physician may at that point counsel them that active treatment is more appropriate because they themselves want to avoid this headache, although there is evidence that we know that having one complication after biopsy does not increase your risk of complications after subsequent biopsies.”