The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance.
PURPOSE
Prostate biopsy related infectious complications are associated with significant morbidity. The risk of infectious complications in patients with prostate cancer on active surveillance remains under studied.


MATERIALS AND METHODS
A total of 591 consecutive men who underwent prostate biopsy were prospectively enrolled in a study evaluating prostate biopsy related complications between January 2011 and January 2012. Of these men 403 were previously diagnosed with prostate cancer and were included in this study. They underwent a 14-core transrectal ultrasound guided prostate biopsy as part of an active surveillance regimen. A nurse contacted all men within 14 days of biopsy, and information was collected on potential complications, antibiotics received and bacterial culture results.


RESULTS
Fourteen patients (3.5%) had infectious complications including 13 requiring hospitalization. Five patients had positive urine cultures, and fluoroquinolone resistant isolates were identified in 4 patients, including 2 with extended spectrum beta-lactamase producing isolates. We evaluated the impact of risk factors including diabetes, benign prostatic hyperplasia and antibiotic regimen. However, only the number of previous prostate biopsies was significantly associated with an increased risk of infectious complications (p = 0.041). For every previous biopsy the odds of an infection increased 1.3 times (OR 1.33, 95% CI 1.01-1.74).


CONCLUSIONS
In men with prostate cancer on active surveillance the number of previous prostate biopsies is associated with a significant risk of infectious complications and every previous biopsy increases the risk of infectious complication. Fluoroquinolone resistant and extended spectrum beta-lactamase producing isolates represent the most commonly identified organisms. Men with prostate cancer on active surveillance should be informed of the risks associated with serial repeat prostate biopsies.
['Ehdaie|Behfar|B|', 'Vertosick|Emily|E|', 'Spaliviero|Massimiliano|M|', 'Giallo-Uvino|Anna|A|', 'Taur|Ying|Y|', "O'Sullivan|Maryellen|M|", 'Livingston|Jennifer|J|', 'Sogani|Pramod|P|', 'Eastham|James|J|', 'Scardino|Peter|P|', 'Touijer|Karim|K|']
D000368:Aged D000900:Anti-Bacterial Agents D001706:Biopsy D024881:Drug Resistance, Bacterial D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011446:Prospective Studies D011471:Prostatic Neoplasms D019233:Retreatment D012307:Risk Factors D013530:Surgical Wound Infection D016896:Treatment Outcome D018084:Ultrasonography, Interventional
biopsy infection prostatic neoplasms sepsis treatment outcome