In 2012, authors of the Preventive Services Task Force noted a decrease in prostate biopsies, possibly due to an emphasis on active surveillance for the management of low-grade prostate disease. In this approach, repeat prostate biopsy is an integral component. Repeated biopsies are associated with an increase in cumulative infection risk due to fluoroquinolone exposure for prophylaxis. Complications related to prostate biopsy can range from minor to life threatening.
In its 2016 White Paper on the Prevention and Treatment of Common Complications Related to Prostate Biopsy, the American Urological Association provides an updated critical review of the literature, addressing the incidence, etiology, risk factors, prevention, and treatment of prostate biopsy-related complications.
The purpose of the 2016 update is to:
--Identify the prevalence of common complications of prostate biopsy to facilitate up-to- date informed consent and to guide shared decision-making process.
--Determine prevention strategies for the most common complications from prostate biopsy, especially in response to the rise in infectious complications.
--Recognize early signs of complications and implement appropriate strategies to minimize patient morbidity and mortality.
Updates from 2012 include:
- A Focus on prevention and early treatment of complications
- Expanded discussion on infection and prostate biopsy
- Discussion on informed consent
- Expanded topics such as erectile dysfunction and needle tract seeding
- Expanded discussion on bleeding complications
Recommendations in the 2016 update include an informed consent in which the [health care provider] discusses the risks and benefits of prostate biopsy before a shared decision making whether or not to proceed. The typical risks of prostate biopsy and their frequency are listed.
1. A risk assessment should be performed on all patients to identify known risk factors for harboring fluoroquinolone resistance, especially healthcare workers or those with recent travel, antibiotics, or hospitalizations.
2. Immunocompromised patients may need special attention and assistance from infectious disease specialists.
3. The AUA Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis suggests a fluoroquinolone for less than 24 hours.
4. Check local antibiograms for current local levels of fluoroquinolone resistance.
5. Check current equipment and cleaning practices. Adhere to guidelines regarding cleaning equipment, checking probes, and changing lubricant containers often.
6. Consider stopping anticoagulation if possible, though this is unlikely to significantly impact bleeding risk.
7. Confirm medications prior to prostate biopsy.
8. Review reasons to return to the emergency room (ER) at the completion of the biopsy
9. [State that] the onset of fever and/or chills should prompt the patient to return for evaluation
10. [Implement[ empiric intravenous treatment with carbapenems, amikacin, or second- and third-generation cephalosporins can be considered until culture sensitivities are known. 11. Do not use oral Bactrim if bacteremia is suspected.
Liss MA, Edaie B, Loeb S, et al. AUA White Paper on The Prevention and Treatment of the More Common Complications Related to Prostate Biopsy Update. American Urological Association, Education and Research, Inc. Available at: