Prostate Biopsy Complications: A Dual Analysis: Beyond the Abstract

Prostate Needle Biopsy (PNB) in general is a relatively minor, painless and uncomplicated procedure most often performed in the office setting under ultrasound guidance. However, on occasion serious complications may ensue and rare cases of death have been reported due to overwhelming sepsis related to antibiotic resistant organisms.
According to a SEER based study using administrative claims-based data, hospitalization related to PNB complications has been reported as high as 6.9%. Other studies have reported lower 1.40% hospitalization rates.

The purpose of our study was examine the incidence and type of complications that occurred following 2,588 Prostate Needle Biopsies over a 30 month period in our Integrated Urology Group Practice, Genesis Healthcare Partners in San Diego.

We used a proprietary software platform, WizMD™ to automatically abstract/mine data from our Allscripts™ EMR (both PM and Clinical) as well as manual review of charts to ensure causality related to the biopsy. We defined a serious PNB related complication as an unintended but related hospital, Emergency Department (ED), Urgent Care (UC) or doctor’s office visit within 30 days. Causality was defined according to a direct relationship between biopsy and adverse outcome. The study included 2 components: an EMR data abstraction and a direct- to- patient questionnaire asking details of their biopsy and any related complications.

According to the EMR study, we identified 69 (2.67%) serious complications leading to either hospitalization, treatment at an Emergency Department (ED), Urgent Care (UC), or doctor’s office. Thirty patients experienced serious complications resulting in hospitalization (1.16%). In contrast, the questionnaire study revealed that 4.25% of patients experienced serious complications of whom 1.06% were hospitalized. We observed that more than 50% of serious complications did not result in hospitalization and were managed in the outpatient setting (ED, UC, and doctor’s office). Similar to another published study, we found no difference in infectious complications in men undergoing a repeat PNB compared to those undergoing their first biopsy.

Our findings in summary were:

Slightly > 1 % of patients were hospitalized according to both studies
56% of patients were managed outside of the hospital
65 % of complications were infections
Non Infectious Complications (35 %) included Urinary Retention, Severe/Persistent gross hematuria, Rectal Bleeding (requiring transfusion)

The results of our study suggest that approximately 1 % of men undergoing PNB face the risk of being hospitalized for a serious PNB related complication. We at Genesis Healthcare Partners have developed a best practice process measure in collaboration with the Department of Urology at the University of California, San Diego to mitigate PNB associated complications. The best practice is a time out requiring physicians performing a PNB to ensure that the patient is managed with either a tailored antibiotic regimen based on a pre-biopsy rectal culture or dual antibiotics including a parental antibiotic such as Gentamicin or Ceftriaxone. This approach has been shown by the MUSIC group from Michigan to reduce hospitalization for sepsis by 53%.

Written by:
Franklin Gaylis MD, FACS, Chief Scientific Officer, Genesis Healthcare Partners, Voluntary Professor of Urology, University of California, San Diego

Paul Dato MD, Medical Director, Genesis Healthcare Partners

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