PCA3 Materials & News

• This article was published online on 6 May 2011 by the economic news website Bloomberg.com
• It discusses that among men undergoing prostate biopsy for detection of prostate cancer, there is an increasing number of cases of drug-resistant bacterial infections leading to hospitalisation and potentially death. This trend is forcing physicians to rethink their approach to prostate cancer diagnosis and potential overuse of prostate biopsy
• Recent studies have shown that a small, yet growing percentage of men undergoing prostate biopsy are becoming critically ill and are dying from bacterial infections
• A population-based study including more than 40,000 men with a negative biopsy showed that the 30-day hospital admission rate after prostate biopsy increased from 1.0% in 1996 to 4.1% in 2010¹. The majority of hospital admissions (72%) were related to bacterial infections. Nine out of 10,000 men died within a month. The reason for the increase in hospital admissions for bacterial infections after biopsy is not known but may be due to an increase in the number of biopsy cores and/or bacterial resistance to existing antibiotics
• At the 2010 annual meeting of the American Urological Association (AUA) five separate groups presented their post-biopsy infectious complication rate². According to Dr. C. Nickel these presentations were a wake-up call for the urological community and serious lessons can be learned from them. The risk of serious infectious complications requiring hospitalisation after biopsy is not trivial. A total of 1.2% of 66,811 men undergoing biopsy in these studies developed urosepsis, with the majority being admitted to hospital. This problem has been increasing over time 
• Bell and colleagues³ reported on three male physicians who underwent prostate biopsies for elevated PSA levels and/or a suspicious digital rectal examination (DRE). All three men developed urosepsis secondary to multi-drug resistant organisms despite antibiotic prophylaxis, and one of these men died. Dr. Bell commented that ‘he’s much more reluctant to recommend a biopsy unless there’s good evidence a patient has a malignancy, and that it needs to be identified and treated’.
• Men susceptible to harbouring resistant bacteria include those who have taken antibiotics in the year before the biopsy, who have recently visited countries where resistance is common in the community and healthcare workers
• The trend of increasing serious infection rates after prostate biopsy is forcing physicians to rethink their approach to prostate biopsies. This newly uncovered risk is adding to the concern that biopsies are being overused. Prostate biopsies are also controversial because a cancer diagnosis may lead to overtreatment and doesn’t necessarily lead to a reduction in prostate cancer mortality
• Mr. Johnson, an infectious diseases physician, commented: ‘the more dangerous the biopsy becomes because of infection risk, the more likely the balance is shifting toward harm, rather than benefit’.
  1. Nam RK, et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2010;183:963-9
  2. Nickel JC, et al. Best of the AUA annual meeting; highlights from the 2010 American Urological Association meeting, May 29–June 3, 2010, San Francisco, C. Rev Urol 2010;12: e134–e146; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931291/
  3. Carlson WH, et al. Multi-drug resistant E.coli urosepsis in physicians following transrectal ultrasound guided prostate biopsies-three cases including one death. Can J Urol 2010;17:5135-7 

More information: Article at Bloomberg.com