Presentation Authors: Jonathan Shoag, Michael Gross*, Morgan Pantuck, Michael Gorin, New York, NY, Edward Schaeffer, Chicago, IL, Tianyi Sun, Art Sedrakyan, Andrew Vickers, Jim Hu, New York, NY
Introduction: Prostate biopsy is a common procedure that many U.S. men endure during their lifetime. Prior population-based studies from over a decade ago found the risk of post-biopsy infections was increasing. Targeted prophylaxis using rectal swab cultures obtained prior to prostate biopsy has been suggested by professional guidelines as a way to reduce the risk of infection. We aimed to characterize recent trends in post-biopsy infections and to assess the utilization of targeted antimicrobial prophylaxis.
Methods: We analyzed Surveillance, Epidemiology and End Results (SEER)-Medicare data to identify 246,299 male Medicare beneficiaries aged over 65 years who underwent prostate biopsy between 2001 and 2013. The primary outcome was infection and death within 30 days of prostate biopsy. Secondary outcomes included infections requiring admission to the emergency department (ED) and subsequent discharge, infection requiring hospital admission, and intensive care unit (ICU) admission. Temporal trends in use of prostate biopsy was evaluated using negative binomial regression. Logistic regression was used to derive odds ratios of the year-to-year change in post-biopsy infections, death, and the use of rectal swabs for targeted prophylaxis.
Results: The number of post-biopsy infections increased from 5.9% in 2001 to 7.6% in 2013, OR 1.02 (95% CI 1.02 to 1.03), p < 0.001. Similarly, post-biopsy emergency room visits rose from 0.2% to 0.5%, OR 1.09 (95% CI 1.07 to 1.11), hospitalizations went from 0.5% to 1.3%, OR 1.08 (95% CI 1.07 to 1.09), and intensive care unit admissions increased from 0.1% to 0.4%, OR 1.12 (95% CI 1.09 to 1.14), all p < 0.001. The use of rectal swabs remained low, albeit increasing over the time period from 0.2% to 0.9%, OR 1.05 (95% CI 1.03 to 1.07), p < 0.001. The risk of death within 30 days (0.1%) decreased from 2001 to 2013, OR 0.96 (95% CI 0.93 to 1.00), p=0.040, Table.
Conclusions: We used current, nationally representative, population-based, data to demonstrate that the rate of post-prostate biopsy infectious complications continues to increase. Although it is beyond the scope of our study design to assign a reason for this sustained increase, our findings call for an urgent need to identify strategies to effectively combat infectious complications.
Source of Funding: This work was sponsored by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.