Prostate Bx linked to rising hospitalization rates

Transrectal ultrasound (TRUS)-guided prostate biopsy is associated with a rising rate of hospitalization for urinary tract infection, new study results indicate.

The study findings, from a Swedish cancer registry, call for a re-evaluation of the significance of resistance to routine antimicrobial prophylaxis, according to a leading U.S. expert in post-biopsy infection.

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For the study, which was published online ahead of print in the Journal of Urology, the authors looked at records of more than 51,000 men registered in the Swedish Prostate Cancer database who underwent TRUS biopsy between 2006 and 2011. They also compiled data from the National Prostate Cancer Register of Sweden, which captures more than 96% of all newly diagnosed prostate cancers in the country, according to a press release from the Journal of Urology.

Of the men who filled a prescription for urinary tract antibiotics within 30 days of biopsy, 54% filled the prescription in the first week after biopsy, the authors reported. One percent of the men were hospitalized with a urinary tract infection.

Over the 5-year period, the number of men obtaining an antibiotic prescription after biopsy decreased, while 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.

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“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,” said lead investigator Karl-Johan Lundström, MD, of Umeå University, Östersund, Sweden.

Dr. Lundström called the increasing hospitalization trend “concerning” and said it “highlights the importance of carefully evaluating the indications for biopsy, especially in men at increased risk of infection.”

Anthony Schaeffer, MD, of Northwestern University Feinberg School of Medicine, Chicago, who was not involved with the research, commented that the study “adds further support to the emerging data that the number of serious and minor infections of TRUS biopsies are rising worldwide.”

“As with any infection, the incidence and impact is more severe in patients with comorbidities such as diabetes and obesity. Not only should the decision to perform a biopsy be weighed more carefully, but the significance of resistance to routine prophylaxis should be re-evaluated,” Dr. Schaeffer said.

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