While a few other studies have reported a reduction of number of biopsies and a rising risk of post-biopsy complications, this study provides a unique perspective. It represents a large data set that represents most regions of the United States. Further, it’s based on claims data, which makes it more likely to capture the significant complications, use of antibiotics, and comorbidities. However, other clinically important information, such as PSA levels and biopsy results, were not available. Additionally, there is likely an underestimation of certain minor complications (hematuria) that did not generate a claim such as a phone call or nursing care.
A few interesting questions remain. It’s not clear why the presence of diabetes mellitus did not increase the risk of infectious complications, but the prior use of fluoroquinolones increased the risk of bleeding. Also, the increased risk of non-sepsis complications mostly accounted for the increase in complication rate, but could that be a result of increased awareness and change in antibiotic prescribing behavior rather than a real increase?
It is clear that in order to reduce the morbidity of PSA screening and early detection of prostate cancer, more needs to be done. As the authors point out, continued efforts to reduce the relative risk of complications for each individual are vitally important.
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