prostate biopsy

Indications

• diagnosis of prostate cancer
  • generally performed to evaluate elevated serum PSA
  • prostate nodule with serum PSA > 4.0 ng/mL
  • free PSA < 25% with total serum PSA 4.0-10 ng/mL
• staging & grading of prostate cancer
• evaluation of prostatitis

Procedure

• magnetic resonance imaging used in conjunction with transrectal ultrasound for guided biopsy may increase detection of high-risk prostate cancer & reduce detection of low-risk cancer
• transperineal prostate biopsy associated with less risk of procedure associated infection the transrectal prostate biopsy

Radiology

• prostate MRI prior to initial biopsy (if feasible)
• prostate MRI can eliminate 18 of 100 prostate biopsies with no increase in clinically significant prostate cancers

Complications

• infection
  • sepsis
  • prostate infection, prostatitis (0.4-1.0%)
  • urologists may downplay the risk of infection from transrectal biopsy
  • rate for all types of infection following a biopsy variable from urologist to urologist but averages ~5%
  • infection rate may be increasing due to quinolone resistance
    • floroquinolone resistant E coli (< 90%) after prostate biopsy
• hematuria (0.3%)
• urinary retention (0.3%)
• 6.9% of patients need hospitalization within 30 days (vs 2.9% of control group)
• prostate biopsies may spread prostate cancer cells
• nearly all patients experience adverse effect; 10% seek care for prostate biopsy-associated sequellae

Comments:

• it seems that the majority of hospitalizations are not accounted for by the given complication rates (1.0 + 0.3 + 0.3 = 1.6 << 6.9-2.9 = 4)
• is a prostate biopsy for a man with an otherwise 2.9% 30 day hospitalization rate indicated?

Notes

• lack of evidence rebiopsy after 1st negative biopsy reduces morbidity & mortality

More general terms

• tissue biopsy

Additional terms

• prostate
• prostate cancer
• prostate specific antigen (PSA) in serum
• screening for prostate cancer