Complications Of Prostate Biopsy Research Articles

Наш опыт выполнения трансректальной биопсии предстательной железы

This article is devoted to transrectal prostate biopsy in case of suspected prostate cancer. The article presents a technique of prostate biopsy performing with the use of periprostatic anesthesia and magnetic resonance imaging (MRI) of the pelvic organs during repeated biopsies, as well as the ways to reduce the risk of postprocedure infectious complications of prostate biopsy. Prostate biopsy was performed on 31 patients, 51.6 % of them diagnosed with prostate cancer. Complications were observed in 6.5 % of cases.

Povidone Iodine Intrarectal Cleaning versus Formalin Needle Disinfection for Minimizing Transrectal Prostate Biopsy-related Infections

Background: A most feared complication of transrectal prostate biopsy is post-biopsy infection and/or sepsis. Safe intraprocedural measures that complement the antibiotic prophylaxis are intrarectal povidone iodine instillation or formalin needle disinfection after every core of the biopsy. Both are more effective at preventing post-biopsy infection than performing antibiotic prophylaxis alone. Objective: To assess the effectiveness of povidone-iodine intrarectal cleaning and formalin needle disinfection to prevent infection after prostate biopsy. Methodology: This study was conducted from July 2021 to June 2022 with 90 patients who underwent prostate biopsy at NIKDU. Patients were randomized into 2 equal groups, 45 in each group, by lottery. Two groups were Group-F: Standard biopsy, where the needle is disinfected with 10% formalin after each core, and Group-P: intrarectal luminal instillation of 10 ml 10% povidone-iodine for 10 min before the biopsy. Endpoint of the study was the development of signs and symptoms of infection within 7 days of prostate biopsy. Result: In terms of age, S. PSA & prostate volume, there was no significant difference between the two group. Infective complications within 7 days of the prostate biopsy were observed in 14 patients (15.6%), 3.67 times more in Group-F patients (p=0.03), and a higher incidence of UTI (72.73%) was observed in Group-F (p=0.03) than Group- P patients. The incidence of septicemia, epididymal-orchitis, and acute prostatitis was not statistically significant between the two groups. E. coli was the predominant organism found on urine culture, followed by Klebsiella pneumoniae, Enterococcus faecalis, and proteus species. Conclusion: Along with prophylactic antibiotics, povidone iodine intrarectal cleaning is superior to formalin needle disinfection in preventing infective complications of prostate biopsy. Bangladesh J. Urol. 2022; 25(2): 80-83

Common errors, pitfalls, and management of complications of prostate biopsy : The most common diagnostic and procedural challenges of transrectal fusion prostate biopsy in the initial diagnosis of clinically significant prostate cancer

Transrectal (TR) prostate biopsy is the gold standard in diagnosis of prostate cancer (PC). It requires aprecise and safe technique for sample acquisition. Several approaches will be discussed to avoid overdiagnosis, false-negative results, and complications of the procedure. We analyzed national and European guidelines, systematic reviews, meta-analyses, as well as prospective and retrospective studies to describe current trends in indication and performance of biopsies. Incorporation of risk calculators and magnetic resonance imaging (MRI) into daily routine reduces biopsy rates and results in amore precise diagnosis of clinically significant prostate cancer (csPC). Combination of random- and MRI-fusion guided biopsy-but also extending the radius of sampling by 10 mm beyond the MRI lesion and atransperineal (TP) sampling approach- lead to ahigher tumor-detection rate. Bleeding is the most common complication after prostate biopsy and is usually self-limiting. Postbiopsy infection rates can be reduced through TP biopsy. TR MRI-fusion guided biopsy is awidely acknowledged tool in primary diagnostics of csPC. Higher detection rates and safety can be achieved through aTP sampling approach.

SINGLE CENTRE RETROSPECTIVE STUDY COMPARING MAGNETIC RESONANCE-TRANSRECTAL ULTRASOUND (TRUS) FUSION TARGETED AND SYSTEMATIC BIOPSY VERSUS CONVENTIONAL TRUS SYSTEMATIC BIOPSY FOR DETECTING PROSTATE CANCER

Purpose: The aim of this retrospective study is to compare the results of MRI-TRUS fusion targeted and systematic prostate biopsy (TSPB) versus conventional systematic prostate biopsy (SPB), in biopsy naïve patients with available MRI results at time of biopsy. Between January 1, 2018, and May 31, 2022, patients with Materials And Methods: clinical suspicion of prostate cancer based on abnormal PSA level and/or abnormal Digital Rectal Exam (DRE) who were scheduled for prostate biopsy, were included. All patients had undergone multiparametric (mp) MRI before biopsy, and the results of this scan were known to the urologist performing the biopsy. Patients were classied according to whether they had undergone MRI-TRUS fusion targeted + systematic biopsies (TSPB, group 1) or standard TRUS systematic biopsies (SPB, group 2). We compared cancer detection rate (CDR), clinically signicant cancer (ISUP≥2) detection rate, rate of upgrading or downgrading in radical prostatectomy treatment group and prostate biopsy complications. Results: There was no statistically signicant difference in global CDR between group 1 (TSPB) and group 2 (SPB), CDR 59.7% (43/72) and 54.8% (102/186), (p< 0.48), respectively. Prostate cancer prevalence was 56.2% (145/258). There was 3 times higher risk of PCa detection in patients with MRI-visible lesions comparable to those with no MRI-visible lesions, CDR 66% (110/166 patients), and 38% (35/92 patients), OR 3.2 CI [1.9-5.4], (p<0.001), respectively. Rates of upgrading and downgrading on whole-mount histopathological analysis were 23.5% and 17.6% respectively. There was no increased risk of complications rates post prostate biopsy in both groups. In this single centre Conclusion: retrospective study we found no differences in CDR across combined MRI-TRUS fusion + systematic prostate biopsies versus systematic prostate biopsies in men having undergone mpMRI. Knowledge of the anatomical location of the index lesion may benet CDR in patients undergoing standard systematic biopsies. Our study investigated the results of pros Patient summary: tate biopsy strategy in patients suspected of having prostate cancer based on their abnormal PSA level and/or DRE. The results showed that there was no signicant difference between the prostate biopsies done systematically or those done using MRI-TRUS fusion (targeted and systematic) even when there is MRI-visible lesion.

Urinary VPAC1: A potential biomarker in prostate cancer

<abstract> <p>Prostate cancer is ranked as the fourth most prevalent cancer commonly diagnosed among males over 40 years of age, according to the WHO Cancer Fact Sheet 2020, and it is additionally a leading cause of cancer mortality among males. The incidence of prostate cancer and mortality varied significantly across the globe. Diagnosis of prostate cancer hinders easier management of cases, and prostate-specific antigen (PSA) use for screening of prostate cancer has poor specificity and sensitivity, thereby yielding overdiagnosis and unnecessary biopsies. Radiologically guided (ultrasound/MRI) prostate biopsy, considered the gold standard, is invasive and can miss a significant number of metastatic cancers. Even though mild, other prostate biopsy complications occur on a large scale, and few severe ones are often recorded. Scientists intensify their search for biomarker(s) for non-invasive diagnosis of prostate cancer using proteomics, metabolomics, genomics, and bioinformatics—urinary biomarkers were uniquely on the lookout. Vasoactive intestinal peptide (VIP)/pituitary adenylate cyclase-activating peptide (PACAP) receptor 1 (VPAC1), which is overexpressed (a thousandfold) in prostate cancer at the onset of oncogenesis and is excreted in the urine on tumor cells, is a contender in the prostate cancer biomarker quest. VPAC1 is ubiquitous, expressed by normal and malignant cells, and interwoven in their cell membranes. Therefore, using urine samples limits the possibility of making the wrong diagnosis, since VPAC1 is not normally excreted in the urine. Nevertheless, studying transmembrane receptors is intricate. However, producing monoclonal antibodies against the N-terminal end of VPAC1 can provide a promising target for designing a non-invasive diagnostic assay for early detection of prostate cancer using a urine sample.</p> </abstract>

Comparative Effectiveness of Single-Dose of Fosfomycin vs. Cefoxitin Plus Ciprofloxacin as A Prophylaxis to Prevent Transrectal Prostate Biopsy Complications

A total of 432 transrectal ultrasound guided prostate biopsies were performed: 241 patients received prophylaxis with cefoxitin 2 g i.v. 1 hour before the procedure combined with ciprofloxacin 750 mg p.o. 1 hour before and 8 hours after the procedure A total of 184 patients received prophylaxis with single dose of fosfomycin trometamol 3 g oral the night before the procedure Adverse events in the 30 days following the procedure were analyzed.

Варианты антибактериальной профилактики инфекционных осложнений биопсии предстательной железы

Introduction. Amount of prostate biopsy procedures rises every year and up to 95% of cases of prostate biopsy is performed via transrectal approach. The incidence of infectious complications of transrectal prostate biopsy reaches up to 17%, while incidence of such complications of transperineal biopsy is about 1%. The majority of international clinical guidelines recommends for obligatory antibiotic prophylaxis prior to prostate biopsy of any approach, but the choice of antibiotic is still debatable. The aim of this review is to sum up the approaches of international urological guidelines to the antibiotic prophylaxis prior to prostate biopsy. Materials and methods. We analyzed the search results in the scientific databases PubMed, Google Scolar, elibrary.ru for the queries «prostate biopsy», «antibacterial prophylaxis» and «guidelines». Results. According to the recommendations of most professional communities, antibacterial prophylaxis of infectious complications of prostate biopsy can be carried out in various ways - once or for a long time, one- or two-component, empirically or on the basis of urine culture on microflora. Conclusion. Despite the differences in the levels of sensitivity and resistance of coliform flora around the world, the clinical guidelines in most countries are uniform in terms of the choice of drugs to reduce the risk of developing infectious complications after prostate biopsy. Approaches to antibacterial prophylaxis after prostate biopsy differ only depending on the type of biopsy access.

Combined antibiotic prophylaxis of infectious complications of prostate biopsy

Introduction. Biopsy of prostate is a routine urologic procedure. Nevertheless the frequency of infectious-inflammatory complications remain high, despite the recommended antibiotic prophylaxis schemes.Purpose. The evaluation of effectiveness and safety of combined antimicrobial prophylaxis: fosfomycin trometamol and fluoroquinolones of 3rd generation.Materials and methods. Our clinical study included 80 patients who underwent prostate biopsy were divided into 2 groups. The first group of 40 patients received routine prophylaxis: levofloxacin 500 mg 6 h before the biopsy and 500 mg per day during 4 days after biopsy. The second group of 40 patients, along with standard prophylaxis as in the first group, additionally after biopsy received fosfomycin trometamol 3 gr single-shot.Results. In the first group, infectious and inflammatory complications occurred in 8 (20 %) patients, 12.5 % of patients from the first group were hospitalized for parenteral antibiotic therapy. The average length of stay in hospital was 3.4 ± 1.45 days. In all cases, in the first group of patients, Escherichia coli was detected, in 70 % of cases fluoroquinolone-resistant strain of the bacterium was received. In the second group of patients no hospitalization was required. One (2.5 %) patient out of forty from this group showed signs of urinary tract infection, which was not accompanied by an increase of body temperature, as well as changes in blood and urine tests.Conclusions. Our results show good effectiveness and safety of combined antibiotic prophylaxis for transrectal prostate biopsy. Since fluoroquinolone resistance grows, it is necessary to introduce alternative schemes, as well as monitoring of nosocomial infection and controlling of antimicrobial therapy.

MP43-14 COMPARISON BETWEEN QUINOLONES AND OTHER ANTIBIOTICS IN PREVENTING INFECTIVE COMPLICATIONS IN TRANSRECTAL PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP43)1 Sep 2021MP43-14 COMPARISON BETWEEN QUINOLONES AND OTHER ANTIBIOTICS IN PREVENTING INFECTIVE COMPLICATIONS IN TRANSRECTAL PROSTATE BIOPSY Gabriele Tulone, Vincenzo Serretta, Ettore Dalmasso, Marco Vella, Nino Dispensa, Carlo Pavone, Davide Baiamonte, Piero Mannone, Alberto Abrate, Roberta Aimar, Vincenzo Ficarra, Riccardo Bartoletti, and Alchiede Simonato Gabriele TuloneGabriele Tulone More articles by this author , Vincenzo SerrettaVincenzo Serretta More articles by this author , Ettore DalmassoEttore Dalmasso More articles by this author , Marco VellaMarco Vella More articles by this author , Nino DispensaNino Dispensa More articles by this author , Carlo PavoneCarlo Pavone More articles by this author , Davide BaiamonteDavide Baiamonte More articles by this author , Piero MannonePiero Mannone More articles by this author , Alberto AbrateAlberto Abrate More articles by this author , Roberta AimarRoberta Aimar More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , Riccardo BartolettiRiccardo Bartoletti More articles by this author , and Alchiede SimonatoAlchiede Simonato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002064.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sepsis is one of the most feared complications of prostate biopsy: it’s incidence is 1-3%. Prevention of infection after biopsy procedure consists in prophylactic antibiotic therapy. Quinolones were indicated in European and American guidelines as the first-choice antibiotic prophylaxis up to 2018 European Medicine Agency (EMA) restrictions on their use in patients at risk of aortic aneurysms. Guidelines in prostate biopsies placed quinolones as second-choice antibiotic. The goal of our study was to compare the incidence of infective complications of prostate biopsy adopting different antibiotics. METHODS: A retrospective case-control study including all patients submitted to ultrasound-guided transrectal prostate biopsy before and after the publication of the EMA note (2017 to 2019) was conducted in 3 referral urology institutions (Palermo, Cuneo and Pisa). A standard number of 12 biopsy samples was planned. Biopsy complications (fever, haematuria, haematospermia, rectal bleeding, rectal pain and sepsis) were evaluated in patients undergoing prophylaxis with quinolones (levofloxacin, ciprofloxacin, plurifloxacin), cephalosporins (cefixime, ceftriaxone) and trimethoprim /sulfamethoxazole. The data were compared with the variance analysis (ANOVA). A p value <0.05 was considered significant. RESULTS: Data of 1160 patients were collected. Median age was 70 years (IQR 64-75.6) and median PSA 7.36 ng/ml (IQR 5.38-11). The meadian number of biopsy samples was 12 (range 2-18). Among 448 patients (38.6%) undergoing quinolone prophylaxis, 9.6% reported haematuria, 5.4% haematospermia, 4.2% rectal bleeding and 1.13% fever. Among 606 (52.2%) patients receiving non-quinolone drugs (cephalosporins, trimethoprim /sulfamethoxazole) haematuria was reported in 12.2% patients, haematospermia in 15.4%, rectal bleeding in 9.7% and fever in 3.5%. There was a statistically significant difference in the incidence of the complications described between the two populations examined (p < 0.001 for hematuria, hematospermia and rectal bleeding and p = 0.004 for fever). Incidence was independent from center and operator. CONCLUSIONS: After EMA note in 2018, the European Association Urology guidelines recommended the use of cephalosporins or phosphomycin as the first-choice antibiotic prophylaxis of prostate biopsy in patients at risk of aortic aneurysm. In our study quinolone-based prophylaxis was associated with a lower incidence of complications after prostate biopsy in comparison with other antibiotics. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e787-e787 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tulone More articles by this author Vincenzo Serretta More articles by this author Ettore Dalmasso More articles by this author Marco Vella More articles by this author Nino Dispensa More articles by this author Carlo Pavone More articles by this author Davide Baiamonte More articles by this author Piero Mannone More articles by this author Alberto Abrate More articles by this author Roberta Aimar More articles by this author Vincenzo Ficarra More articles by this author Riccardo Bartoletti More articles by this author Alchiede Simonato More articles by this author Expand All Advertisement Loading ...

EDITORIAL COMMENT

We would like to thank the editors for their comment on “Preventing prostate biopsy complications: to Augment or to Swab”. They present some of the challenges to implementing a rectal swab prior to transrectal ultrasound (TRUS) biopsy, and offer an alternative using the transperineal (TP) biopsy approach.

IJU this issue

In this issue, one Review Article, seven Original Articles, two Urological Notes and nine Editorial Comments (total 19 manuscripts) are published. Shigemura and Fujisawa (Hyogo, Japan) reviewed the prevention and management of infectious complications in prostate biopsy. Miyamoto et al. (Nara, Japan) reported on the clinical outcomes after intravesical bacillus Calmette–Guérin for the highest-risk non-muscle-invasive bladder cancer newly defined in the Japanese Urological Association Guidelines 2019. Tabei et al. (Kanagawa, Japan) investigated the efficacy of re-do urethroplasty for post-traumatic urethral stricture in terms of anatomical and functional outcomes to show a high success rate and beneficial effects on both anatomical and functional outcomes. Taoka et al. (Kagawa, Japan) showed the therapeutic benefits of a surgical checklist in improving the quality of resection during transurethral resection and reducing the recurrence rate in patients with non-muscle-invasive bladder cancer. Hata et al. (Fukushima, Japan) identified the preoperative low bladder contractile index as the predictor of postoperative detrusor underactivity during the early postoperative period after robot-assisted radical prostatectomy. Shin and Mimata (Oita, Japan) described the “early pull-out” technique for intracorporeal ileal conduit urinary diversion after robot-assisted radical cystectomy. Aizawa et al. (Kyoto, Japan) reported that prostate-targeted treatment plus metastasis-directed therapy through external beam radiation therapy can result in favorable long-term disease-free and survival outcomes with acceptable morbidities among synchronous oligometastatic prostate cancer patients. Iguchi et al. (Osaka, Japan) reported that enzalutamide plus androgen deprivation therapy has clinical benefit with a tolerable safety profile in Japanese men with metastatic hormone-sensitive prostate cancer, consistent with the overall population. Yamashita et al. (Wakayama, Japan) evaluated the prognostic impact of sarcopenia and myosteatosis on survival after radical cystectomy for bladder cancer. Unfortunately, the limited space does not allow me to introduce all the papers. However, all the articles in this issue are very informative and interesting, so please enjoy it by all means. None declared.

Prevention and management of infectious complications in prostate biopsy: A review

Prostate biopsies are common procedures for urologists, performed in order to detect and diagnose prostate cancer. Procedures continue to evolve, for instance, recently there has been an increase in the use of the transperineal approach, and the emergence of antibiotic-resistant bacteria has become a challenge. This review examines the recent prostate biopsy literature as well as the guidelines of three urological associations. We review the recent literature, including our own recent studies, and the Japanese Urological Association, European Association of Urology and American Urological Association guidelines, and summarize the current recommendations regarding the prevention of infectious complications that can occur after prostate biopsy, including the use of antimicrobial agents, and the management and treatment of such complications. Current recommendations include single-dose or 1-day use of oral quinolones for infection control, along with consideration of high-risk patients with diabetes, steroid use, large prostates, or high residual urine volume for instance. Targeted therapies based on the results of rectal swabs carried out prior to transrectal prostate biopsy, which can provide better inhibitory data with regard to post-prostate biopsy infectious complications, can also be considered. In conclusion, oral quinolones for low-risk patients and targeted therapies for high-risk patients are recommended when using a transrectal approach to prostate biopsy, and oral quinolones are recommended when using a transperineal approach. Further randomized controlled trials are necessary to draw more definitive conclusions.

Evaluation of the Forsvall biopsy needle in an ex vivo model of transrectal prostate biopsy – a novel needle design with the objective to reduce the risk of post-biopsy infection

Background Transrectal prostate biopsy (TRbx) transfers colonic bacteria into prostatic tissue, potentially causing infectious complications, including sepsis. Our objective was to determine whether biopsy needle shape, surface properties and sampling mechanism affect the number of bacteria transferred through the colon wall, and evaluate a novel needle with improved properties. Methods The standard Tru-Cut biopsy needle used today was evaluated for mechanisms of bacterial transfer in a pilot study. A novel Tru-Cut needle (Forsvall needle prototype) was developed. TRbx was simulated using human colons ex-vivo. Four subtypes of the prototype needle were compared with a standard Tru-Cut needle (BARD 18 G). Prototype and standard needles were used to puncture 4 different colon specimens in 10 randomized sites per colon. Needles were submerged into culture media to capture translocated bacteria. The media was cultured on blood agar and then the total amount of transferred bacteria was calculated for each needle. The primary outcome measure was the percent reduction of bacteria translocated by the prototype needles relative to the standard needle. Secondary outcome measures were the effects of tip design and coating on the percent reduction of translocated bacteria. Results Prototype needles reduced the number of translocated bacteria by, on average, 96.0% (95% confidence interval 93.0-97.7%; p < 0.001) relative to the standard needle. This percent reduction was not significantly affected by prototype needle tip style or surface coating. Conclusions The Forsvall needle significantly reduces colonic bacterial translocation, suggesting that it could reduce infectious complications in prostate biopsy. A clinical trial has been initiated.

Preventing Prostate Biopsy Complications: to Augment or to Swab?

ObjectiveTo use data from a large, prospectively- acquired regional collaborative database to compare the risk of infectious complications associated with three American Urologic Association- recommended antibiotic prophylaxis pathways, including culture-directed or augmented antibiotics, following prostate biopsy. MethodsData on prostate biopsies and outcomes were collected from the Pennsylvania Urologic Regional Collaborative, a regional quality collaborative working to improve the diagnosis and treatment of prostate cancer. Patients were categorized as receiving one of three prophylaxis pathways: culture-directed, augmented, or provider-discretion. Infectious complications included fever, urinary tract infections or sepsis within one month of biopsy. Odds ratios of infectious complication by pathway were determined, and univariate and multivariate analyses of patient and biopsy characteristics were performed. Results11,940 biopsies were included, 120 of which resulted in infectious outcomes. Of the total biopsies, 3246 used “culture-directed”, 1446 used “augmented” and 7207 used “provider-discretion” prophylaxis. Compared to provider-discretion, the culture-directed pathway had 84% less chance of any infectious outcome (OR= 0.159, 95% CI = [0.074, 0.344], P < 0.001). There was no difference in infectious complications between augmented and provider-discretion pathways. ConclusionsThe culture-directed pathway for transrectal prostate biopsy resulted in significantly fewer infectious complications compared to other prophylaxis strategies. Tailoring antibiotics addresses antibiotic-resistant bacteria and reduces future risk of resistance. These findings make a strong case for incorporating culture-directed antibiotic prophylaxis into clinical practice guidelines to reduce infection following prostate biopsies.

Association of local anesthetic method and prostate volume with the occurrence of prostate biopsy complications

Background: Due to the invasive nature of prostate biopsy, it is associated with various complications. The study aimed to determine the association of local anesthetic method and prostate volume with the occurrence of these prostate biopsy complications. Materials and Methods: It was a prospective study carried out in 106 patients with indications for prostate biopsy. They were randomized into two equal groups receiving either intrarectal lidocaine gel or periprostatic nerve block. Prostate volume was determined using transrectal ultrasound, and patients were further divided into three prostate volume classes (20-40 ml, 40-100 ml, and ≥100 ml). Systematic sextant prostate biopsy was done, and the occurrence of complications (pain, bleeding, infection, and urinary retention) was documented. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. Results: The pain scores of patients were similar irrespective of their prostate volume even with the use of different types of anesthesia. There was no significant tendency for the occurrence of bleeding, infection, and voiding complications when periprostatic nerve block or intrarectal lidocaine gel was used for pain relief. Postbiopsy cystourethritis was, however, significantly associated with the volume of the prostate (P = 0.006). Conclusion: The choice of local anesthesia does not affect the occurrence of complications following transrectal prostate biopsy. There is, however, a significant potential for the development of postbiopsy cystourethritis in patients with larger prostates.

Evaluation cut-off point of Prostate-Specific Antigen (PSA) and Prostate-Specific Antigen (PSA)-density in prostate cancer suspected patients at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: PSA is a test performed to detect prostate cancer. There is currently no rational standard for its cut-off point, resulting in the increasing number of patients with prostate biopsy complications. This study aims to determine the estimated cut-off point of PSA and PSAD among patients with suspected prostate cancer (PCa) in Makassar.Methods: A single-center retrospective analysis using a cross-sectional design was applied in this research. The sample was obtained through medical record data from benign prostate enlargement (BPE) and PCa patients in three affiliate hospitals from January 2014 to December 2019. Mann-Whitney U, Chi-Square, Fisher's Exact, and ROC tests were performed in the statistical analysis (considered significant if p &lt;0.05). Data were analyzed using SPSS version 22 for Windows.Results: Among 470 subjects, 88.3% were BPE patients, and 11.7% were PCa. Lower urinary tract symptoms (LUTS) were found in 70.6% of patients, and those with hematuria remained at 10.6%. The average prostate volume was 53.8±25.72 ml. The prostate consistency examination with the digital rectal examination (DRE) made up 84.3% Solid Chewy in the BPE sample and 96.4% hard solid in the PCa sample. The average PSA value in BPE was 14.82±20.1 ng/ml, and the PCa was 48.10±42.58 ng/ml, while the average PSAd BPE value was 0.287±0.40 ng/ml, and PCa was 1.19±1.32 ng/ml. PSA cut-off point was 18.62 ng/ml. PSAD cut-off point was 0.533.Conclusion: PSA and PSAD cut-off points in this study 18.62 ng/ml and 0.533. The cut-off point obtained is far higher than the value agreed upon in advance.

Erectile Dysfunction is a Transient Complication of Prostate Biopsy: A Systematic Review and Meta-Analysis.

Because the association between erectile dysfunction and prostate biopsy is variable in the available literature, we sought to perform a systematic review and meta-analysis of sexual dysfunction in males within 6 months of prostate biopsy. We conducted a systematic literature search in 4 databases: MEDLINE® (via PubMed®), Embase® (via Ovid®), Web of Science™ and the Cochrane Library. We included studies focused on sexual dysfunction in men of all age groups undergoing transrectal or transperineal prostate biopsy for suspicion of prostate cancer. We included studies with International Index of Erectile Function 5 scores pre-biopsy and post-biopsy at 1, 3 or 6 months. We performed an effect size meta-analysis comparing patient baseline International Index of Erectile Function 5 (IIEF-5) scores with post-biopsy IIEF-5 scores. We identified 9 studies that met our inclusion criteria, of which 6 examined transrectal prostate biopsy, 2 examined transperineal prostate biopsy and 1 examined both. At 1 month after biopsy, the mean IIEF-5 score decreased by approximately 2.2 points as determined by the effect size (-0.43, p=0.002). However, at 3 and 6 months after biopsy, there was no difference compared to baseline (effect size=-0.08, p=0.52 and effect size=-0.11, p=0.18, respectively). An exploratory subgroup analysis examining transrectal prostate biopsy at 3 months showed a statistically significantly lower mean IIEF-5 score compared to baseline (p=0.047), corresponding to an approximately 1.25-point decrease in IIEF-5. Prostate biopsy does cause a mild, transient decrease in average IIEF-5 scores at 1-month post-biopsy. However, this resolves at 3 months on average, and average IIEF-5 remains at baseline at 6 months post-biopsy.

The impact of complications after diagnostic biopsy on repeat biopsy in men: Results from the Prostate Cancer Research International: Active surveillance (PRIAS-JAPAN) study.

e17616 Background: Active surveillance(AS) is the strategy to avoid the overtreatment for favorable prostate cancer. For safer AS protocol execution, repeat protocol biopsy is essential in evaluating cancer aggressiveness accurately. However, some men on AS refuse repeat protocol biopsy because of burdens on biopsy. We aimed to assess the complications of prostate biopsy and the impact of complications after diagnostic biopsy on repeat protocol biopsy from the analysis Japanese cohort forming part of the Prostate cancer Research International: Active surveillance (PRIAS) study. Methods: PRIAS-JAPAN started in January 2010, 39 institutions are participating in this study. Men are prospectively followed and repeat protocol biopsy are planned at 1 year and 4 years thereafter, or if prostate specific antigen-doubling time is &lt; 10 years. Data was collected on the complications such as infection, hematuria, hematospermia, pain, and antibiotics, and approach of biopsy, retrospectively. We compared the complications in diagnostic biopsy between repeat biopsy acceptance group and repeat biopsy non-acceptance group at 1 year. Results: From 2010 to 2018, 862 men with low-risk prostate cancer were prospectively enrolled in PRIAS-JAPAN. 794 men (92%) actually proceeded to protocol at 1 year. Of the 794 men, repeat protocol biopsy non-acceptance rate at 1 year was 18.4%(146 men). According to differences in the complications of diagnostic biopsy, hematuria(p = 0.003) and pain(p &lt; 0.001) rate were significantly higher in repeat biopsy non-acceptance group, but infection(p = 0.105) and hematospermia(p = 0.224). Approach of biopsy(p = 0.651) was not different in two groups. Conclusions: Hematuria and pain in diagnostic biopsy were significantly more frequent in repeat biopsy non-acceptance group. Our study supports the importance of adequate explanation and management of the complications at biopsy to improve the rate of protocol biopsy acceptance. [Table: see text]

MP66-11 HOW TO PREVENT PROSTATE BIOPSY COMPLICATIONS: TO AUGMENT OR TO SWAB?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III (MP66)1 Apr 2020MP66-11 HOW TO PREVENT PROSTATE BIOPSY COMPLICATIONS: TO AUGMENT OR TO SWAB? Lydia Glick*, Timothy M. Han, Christopher Caputo, Danielle Squadrito, Joon Yau Leong, Claudette Fonshell, Kaynaat Syed, John Danella, Serge Ginzburg, Thomas J. Guzzo, Thomas Lachoney, Jay D. Raman, Marc C. Smaldone, Robert Uzzo, Jeffrey Tomaszewski, Adam C. Reese, Edouard J. Trabulsi, Leonard G. Gomella, and Mark J. Mann Lydia Glick*Lydia Glick* More articles by this author , Timothy M. HanTimothy M. Han More articles by this author , Christopher CaputoChristopher Caputo More articles by this author , Danielle SquadritoDanielle Squadrito More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Claudette FonshellClaudette Fonshell More articles by this author , Kaynaat SyedKaynaat Syed More articles by this author , John DanellaJohn Danella More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Thomas J. GuzzoThomas J. Guzzo More articles by this author , Thomas LachoneyThomas Lachoney More articles by this author , Jay D. RamanJay D. Raman More articles by this author , Marc C. SmaldoneMarc C. Smaldone More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Adam C. ReeseAdam C. Reese More articles by this author , Edouard J. TrabulsiEdouard J. Trabulsi More articles by this author , Leonard G. GomellaLeonard G. Gomella More articles by this author , and Mark J. MannMark J. Mann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000941.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate biopsies are the current gold standard for the diagnosis of prostate cancer, but there is a lack of consensus regarding optimal prophylactic approach for infection prevention. Urology guidelines suggest a single agent or targeted therapy based on rectal swab cultures, balancing patient safety with antibiotic stewardship. The goal of this study was to determine if one prophylaxis method was superior to another at preventing infectious outcomes. METHODS: Data collected from the Pennsylvania Urologic Regional Collaborative was analyzed for patient, prostate and biopsy characteristics. Special attention was paid to antibiotic prophylaxis pathway: patients received “Culture-Directed” (based on rectal swab culture), “Augmented” (baseline antibiotic + another based on local antibiogram) or no specific antibiotic pathway. A univariate and multivariate analysis assessed predictors of infectious outcome including fever, urinary tract infection or sepsis. A Chi-square test was used to compare association between each prophylaxis pathway and occurrence of emergency department visit or readmission secondary to biopsy complication within 30 days. RESULTS: Data from 11,941 biopsies was collected. Predictors of infectious outcomes included a history of diabetes. Type of antibiotic prophylaxis pathway was not predictive of infectious outcome on multivariate analysis (Table 1). Chi-square analysis revealed a significant association (p < 0.001) between prophylaxis pathway and both ED visit and readmission within 30 days (Table 2). CONCLUSIONS: Antibiotics pathway was not associated with infectious outcome. However, hospital readmission and ED visit following biopsy were associated with type of antibiotic prophylaxis pathway used. Emergency visits and readmission may be an additional way to capture adverse events. Efforts to integrate culture-directed prophylaxis into urologic practices should be considered to benefit patient outcomes and limit antibiotic resistance. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e987-e987 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lydia Glick* More articles by this author Timothy M. Han More articles by this author Christopher Caputo More articles by this author Danielle Squadrito More articles by this author Joon Yau Leong More articles by this author Claudette Fonshell More articles by this author Kaynaat Syed More articles by this author John Danella More articles by this author Serge Ginzburg More articles by this author Thomas J. Guzzo More articles by this author Thomas Lachoney More articles by this author Jay D. Raman More articles by this author Marc C. Smaldone More articles by this author Robert Uzzo More articles by this author Jeffrey Tomaszewski More articles by this author Adam C. Reese More articles by this author Edouard J. Trabulsi More articles by this author Leonard G. Gomella More articles by this author Mark J. Mann More articles by this author Expand All Advertisement PDF downloadLoading ...

Infectious complications of prostate biopsy: winning battles but not war

Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications. In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined. Management of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy. Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members-included MDRs-although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.