Prostate Biopsy Standards Needed

First large study of complications after transrectal ultrasound guided prostate biopsy shows significant rise in hospital admission rates, and more infection related cases.

In the first, long-term study of its kind, Sunnybrook researchers provide compelling evidence to support much-needed practice standards in transrectal ultrasound guided prostate biopsy.

The 10-year, Canadian population-based study of serious complication rates requiring hospital admission after transrectal ultrasound guided prostate biopsy reports a significant four-fold increase in hospital admission rates over the study period, with over 70 per cent of cases caused by infection. The findings from this study, which is the largest conducted to-date, are published today in The Journal of Urology.

Transrectal ultrasound guided prostate biopsy is the most common method to confirm a prostate cancer diagnosis by obtaining tissue from the prostate gland using a small probe and echoes of ultrasound waves to form a picture through the wall of the rectum. The procedure is not standardized despite the test's diagnostic effectiveness.

"Data from this study add critical momentum for the development of standards to make transrectal ultrasound guided prostate biopsy as safe as possible for patients," says Dr. Robert Nam, lead investigator and urologic oncologist, Genitourinary Cancer Care team, Sunnybrook's Odette Cancer Centre.

The researchers suggest possible factors in the increase of complications including non-standardized practice of antibiotic prophylaxis, inconsistent use of mechanical bowel preparation, and increasing rates of bacterial resistance to antibiotics. Sunnybrook has developed a comprehensive approach to preventing complications after transrectal ultrasound guided prostate biopsy procedures, for every patient.