Presentation Authors: Adrian Sosenko*, Thomas Lanchoney, Thomas Guzzo, Edouard Trabulsi, Hershey, PA, John Danella, Herhsey, PA, Mark Mann, hershey, PA, Adam Reese, philadelphia, PA, Jeffrey Tomaszewski, hershey, PA, Serge Ginzburg, philadelphia, PA, Robert Uzzo, Marc Smaldone, hershey, PA, Claudette Fonshell, herhsey, PA, Bret Marlowe, Jay Raman, hershey, PA
Introduction: Prostate needle biopsy (PNB) remains the referent standard for the diagnosis of prostate cancer. Contemporary data highlights an increase in PNB related infections particularly when performed via the transrectal approach. Non-infectious complications, however, may similarly contribute to biopsy related morbidity. Appropriate patient counseling merits recognition and discussion of such risks. Therefore, we review the incidence and predictors of non-infectious complications following PNB in a large quality registry.
Methods: The Pennsylvania Urologic Regional Collaboration (PURC) is a physician-led quality collaborative focusing on prostate cancer diagnosis and therapy. Established in 2015, 9 participating practices encompassing 108 urologists have accrued over 8,100 men into this data registry. The incidence and distribution of non-infectious PNB complications were evaluated. Logistic regression determined the association of clinical and pathologic variables with the most common non-infectious complications.
Results: 8102 men underwent a transrectal ultrasound guided biopsy of which 84% were an initial biopsy, 11% had one prior biopsy, and 5% had multiple prior biopsies. 277 of 8102 (3.4%) men experienced a biopsy related complication including 199 (2.5%) that were non-infectious and 78 (0.9%) that were infection-related (p < 0.001). The most common non-infectious complications included bleeding (n=74; 0.9%) and urinary retention (n=70; 0.9%). Of the 199 non-infectious complications, 111 (56%) resulted in an ED visit and 54 (27%) were admitted to the hospital. With respect to post-biopsy urinary retention, increasing gland size (OR 1.07 per 5cc increase, 95% CI 1.01&[minus]1.11, p=0.002) was associated with urinary retention whilst repeat biopsy (p=0.54), presence of cancer (p=0.35), and number of cores (p=0.72) obtained were not. For bleeding complications, no variables were identified to be associated with these events including prior biopsy (p=0.83), number of biopsy cores (p=0.19), presence of cancer (p=0.90), or chronic anticoagulation (p=0.26).
Conclusions: Non-infectious complications following biopsy occurred in 2.5% of men with bleeding (0.9%) and urinary retention (0.9%) being the most common causes. Over 50% of these non-infectious complications required an ED visit and over one-quarter needed hospital admission. Such information provides an important framework in counseling patients regarding expectations following prostate biopsy.