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David Mittleman
David Mittleman
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The Most Feared Complication of Prostate Biopsy

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For men 50 and over, digital rectal exams and PSA (prostate-specific antigen) tests have become a routine part of the annual checkup. These tests can uncover signs of prostate cancer, a disease that kills roughly 29,000 Americans each year. However, before a diagnosis can be made, a doctor needs to perform a procedure known as the prostate biopsy to confirm the presence of prostate cancer. In a biopsy, the doctor uses a needle to collect a sample of cells from the prostate so that a pathologist can distinguish cancerous from noncancerous cells. Prostate biopsy is generally considered a safe and simple procedure, but the main concern is that significant complications such as infections do occur if appropriate preventative measures are lacking.

Not long ago, a friend of mine underwent a transrectal prostate biopsy. To his surprise, this so-called simple procedure was not as simple or as safe as one may be led to believe, because according to him, the experience had taken him to "hell and back." The procedure itself went smoothly, but the sequence of events that followed was certainly not what he had signed up for. The first unpleasant episode began the very next day after the biopsy, when he found himself shaking so violently and uncontrollably that he thought he was having a seizure. When nighttime came, he suffered yet another violent bout of shakes which, again, lasted for a good half hour or more. Although the seizures discontinued after that, he was pretty much vegged out in bed for several days, and naturally, he became convinced that he was only suffering from a nasty flu. It was not until he had spoken to his friend, who is a physician, about his symptoms that he realized he was in for a long haul. He immediately contacted his doctor, and was told to get himself over to the emergency room ASAP. After running through bags of saline and drips of antibiotics, he was informed that he had E. coli bacteria in his blood stream which, if left untreated, could be life-threatening. If he hadn’t relayed his symptoms to his friend, he would have continued to believe that it was only a flu, and in the meantime, the infectious bacteria in his blood stream would have attacked his organs and eventually causing them to shut down.

As horrifying as it is, the fact of the matter is that about 800,000 men undergo prostate biopsy every year, and not every doctor perform sufficient preoperative preparation such as appropriate bowel preparation or pretreatment with antibiotics. Although different pre-biopsy protocols for bowel preparation have been suggested, there remains a lack of standardized consensus among urologists. However, studies have found a high infection rate associated with self-administered phosphate enema, also known as the traditional bowel preparation. An enema is a way of cleaning out the large intestine by introducing solutions into the rectum, causing it to expand, and thereby allowing the bowel to empty. Studies have shown that phosphate enema with providone-iodine administered at the hospital can reduce infectious complications for people who have poor compliance or inaccuracy when bowel preparations are self-administered.

Pretreatment with antibiotics is another effective way of reducing complications. Studies have shown that fever may be expected to develop in about 23% of patients who do not receive prophylactic antibiotics, and that infection rate was significantly lowered with the use of antibiotics. Furthermore, the cost of antibiotic medication was about $18 per patient and the cost-effectiveness compared to no prophylactic therapy at all was considered good. Although there are a variety of prophylactic regimens available, Dr. Jeffrey Pollen and Dr. Daniel Smiley’s studies indicate that ciprofloxacin prophylaxis substantially lowers the incidence of fever, especially when started preoperatively. Therefore, it is recommended that physicians who have not yet done so should consider a similar cost-effective policy.

The content provided here is for informational purposes only, and was not designed to replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding prostate biopsy and/or the use of antibiotics.