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prostate biopsy

Indications: 1) diagnosis of prostate cancer - generally performed to evaluate elevated serum PSA - prostate nodule with serum PSA > 4.0 ng/mL [4] - free PSA < 25% with total serum PSA 4.0-10 ng/mL [5] 2) staging & grading of prostate cancer 3) evaluation of prostatitis Procedure: - magnetic resonance imaging used in conjunction with transrectal ultrasound for guided biopsy may increase detection of high-risk prostate cancer & reduce detection of low-risk cancer [6,8] - transperineal prostate biopsy associated with less risk of procedure associated infection the transrectal prostate biopsy [12] Complications: - infection - sepsis [9] - prostate infection, prostatitis (0.4-1.0%) - urologists may downplay the risk of infection from transrectal biopsy [9] - rate for all types of infection following a biopsy variable from urologist to urologist but averages ~5% [9] - infection rate may be increasing due to quinolone resistance - floroquinolone resistant E coli (< 90%) after prostate biopsy [10] - hematuria (0.3%) - urinary retention (0.3%) - 6.9% of patients need hospitalization within 30 days (vs 2.9% of control group) [2] - nearly all patients experience adverse effect; 10% seek care for prostate biopsy-associated sequellae [3] Comments: - it seems that the majority of hospitalizations are not accounted for by the given complication rates (1.0 + 0.3 + 0.3 = 1.6 << 6.9-2.9 = 4) - is a prostate biopsy for a man with an otherwise 2.9% 30 day hospitalization rate indicated? Radiology: - prostate MRI prior to initial biopsy (if feasible) [11] - prostate MRI can eliminate 18 of 100 prostate biopsies with no increase in clinically significant prostate cancers [7] Notes: - lack of evidence rebiopsy after 1st negative biopsy reduces morbidity & mortality [1]

Related

prostate prostate cancer prostate specific antigen (PSA) in serum screening for prostate cancer

General

tissue biopsy

References

  1. Journal Watch 21(24):195, 2001 Djavan B et al Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 166:1679, 2001 PMID: 11586201
  2. Loeb S et al. Complications after prostate biopsy: Data from SEER-Medicare. J Urol 2011 Nov; 186:1830 PMID: 21944136
  3. Rosario DJ et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: Prospective evaluation within ProtecT study. BMJ 2012 Jan 9; 344:d7894. PMID: 22232535
  4. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  5. Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, Richie JP, deKernion JB, Walsh PC, Scardino PT, Lange PH, Subong EN, Parson RE, Gasior GH, Loveland KG, Southwick PC. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998 May 20;279(19):1542-7. PMID: 9605898
  6. Siddiqui MM et al Comparison of MR/Ultrasound Fusion-Guided Biopsy With Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer JAMA. 2015;313(4):390-397 PMID: 25626035 http://jama.jamanetwork.com/article.aspx?articleid=2091987 - Schwartz LH, Basch E MR/Ultrasound Fusion-Guided Biopsy in Prostate Cancer. What Is the Evidentiary Standard? JAMA. 2015;313(4):367-368 PMID: 25626034 http://jama.jamanetwork.com/article.aspx?articleid=2091964
  7. Mehralivand A, Shih JH, Rais-Bahrami S et al A Magnetic Resonance Imaging-Based Prediction Model for Prostate Biopsy Risk Stratification. JAMA Oncol. Published online February 22, 2018 PMID: 29470570 https://jamanetwork.com/journals/jamaoncology/article-abstract/2673079
  8. Kasivisvanathan V, Rannikko AS, Borghi M et al MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. March 19, 2018 PMID: 29552975 http://www.nejm.org/doi/full/10.1056/NEJMoa1801993
  9. Wolinsky H, MedPage Today. August 19, 2018 https://www.medpagetoday.com/special-reports/apatientsjourney/74624
  10. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  11. Wei JT et al. Early detection of prostate cancer: AUA/SUO guideline part II: Considerations for a prostate biopsy. J Urol 2023 Jul; 210:54. PMID: 37096575 https://www.auajournals.org/doi/10.1097/JU.0000000000003492
  12. Hu JC, Assel M, Allaf ME et al. Transperineal vs transrectal prostate biopsy - The PREVENT randomized clinical trial. JAMA Oncol. 2024 Sep 19:e244000 [e-pub] PMID: 39298143 https://jamanetwork.com/journals/jamaoncology/fullarticle/2823969