Prostate biopsy-related infections raise transfusion risk

Paradoxically, the authors of a large study did not find a negative effect in functional outcomes analyzed.

Infections that follow transrectal ultrasound (TRUS)-guided prostate biopsies are associated with an increased risk of blood transfusions and increased readmission following radical prostatectomy, even though the infections may have been clinically resolved well before the procedure was conducted, according to a study presented at the AUA annual meeting in San Diego.

Paradoxically, the authors did not find a negative effect in the functional outcomes they analyzed. Results also showed that the risk of additional oncologic therapies was similar despite the presence of an infectious complication after prostate biopsy.

"It may be that infectious complications affect the complexity of the case to increase blood transfusion rates following radical prostatectomy. But at the end, the proportion of the evaluated surgical complications was similar,” said first author Daniel Olvera-Posada, MD, of the Institute for Clinical Evaluative Sciences and the University of Western Ontario London, Ontario, Canada.

"Using administrative data from the province of Ontario, we found that infectious complications significantly increased along the years of the study even though oncological and functional outcomes were similar. Physicians should inform patients who experience infectious complications following a prostate biopsy that although prostatectomy outcomes are similar, there is a slightly increased risk of the need for blood transfusion,” Dr. Olvera-Posada told Urology Times.

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The study noted that no differences were found in the proportion of patients requiring adjuvant radiation, hormonal therapy, or surgical procedures to treat incontinence or erectile dysfunction. The 30-day post-op mortality was not affected. Outcomes were assessed in the first 12 to 24 months after radical prostatectomy.

Next: Study findings

The study was extensive. Using data from the Institute for Clinical Evaluation Services (ICES), the authors identified a population-based cohort of 27,637 patients from Ontario who had undergone a radical prostatectomy between April 2002 and March 2013. Infectious complications were defined as hospitalization with evidence of a urinary tract infection or sepsis within 30 days of a TRUS-guided prostate biopsy.

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A total of 530 patients (1.9%) had an infectious event following biopsy. The primary endpoint was a composite of surgical complications that included the need for postoperative treatment of urinary fistula, intestinal diversion, upper upper urinary tract obstruction, or ureteral repair.

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Patients with a biopsy-associated infection showed a 19.6% rate of transfusion, compared to 13.1% of the non-infectious complication group. The 30-day post-prostatectomy hospital readmission rate for those with infections following biopsy was twice that of those with no recorded infections (6.6% vs. 3.3%; OR: 2.06, 95% CI: 1.46-2.93, p<.0001). The statistical difference in the length of hospital stay was not clinically meaningful.

Next: "It is real-world data"

“The analyzed data come from many centers with dozens of surgeons using different approaches. It is real-world data that includes outcomes from community and teaching hospitals. Unfortunately, the information did not contain patient-level data; however, population-based information represents the real world,” said Dr. Olvera-Posada, working with Stephen E. Pautler, MD, and colleagues.

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"We were using administrative information and were unable to see important variables such as the pathological stage, prostate volume, or baseline urinary function. Those and other variables should be taken into consideration to get a better answer to the clinical questions the study raised," Dr. Olvera-Posada said.

Dr. Olvera-Posada said the research was conducted to add more information regarding the deleterious impact of infectious complications following prostate biopsy. The initial research that raised this issue, published by Nam et al in the Journal of Urology (2010; 183:963-8), found that hospital readmission rates for men undergoing TRUS biopsies in Ontario had quadrupled from 1.0% to 4.1% between 1996 and 2005 (p for trend <.0001) The vast majority (72%) of the readmission rates were related to infections.

"We knew that there is an increased rate of infectious complications following a prostate biopsy. We wanted to find out what effects those complications might have on surgical outcomes following radical prostatectomies," said Dr. Olvera-Posada.