Post-prostate biopsy infections bring concern, calls for standardization

August 1, 2011

Most of the urologists interviewed for this article say post-biopsy infection is something they are watching and that they are considering changes to their regimens to counter the problems that have been reported.

In many cases, antibiotic-resistant infections were the culprit. Even deaths have occurred from these so-called "superbugs" at higher levels than previously seen, drawing the attention of the consumer media.

Urology Times spoke to practicing urologists about their experience with complications following biopsy, their awareness of the problem, and whether their approach to biopsy in men with suspected prostate cancer has changed.

"It seemed funny because I was listening to NPR and getting ready for work a few weeks ago, and I heard my former mentor from my fellowship at Northwestern doing a piece on post-biopsy sepsis on the radio," Dr. Wu recalled. "I called him and found out it's becoming a big deal.

"There were times during fellowship when my mentor, Dr. Robert Nadler, had a couple of patients who got fairly ill. One patient was in the ICU for a while, but there were no deaths, and they got better with antibiotics and fluids.

"Fortunately, I haven't seen the problem first-hand in any of my patients myself, but then again my career has not been as long as my mentor's or some of these other people. It's a rare thing, but it definitely happens."

Dr. Wu took the information back to his office, where his colleague said he, too, had one patient who had to be hospitalized for severe infection.

Although he's not doing extensive pre-testing, Dr. Wu is taking a critical look at patients' history before scheduling a biopsy.

"Generally, before biopsies, I try to clue in on any recent illnesses or reason for antibiotic exposure, and what kind of antibiotics they've been on. Usually, if they've been on something like Cipro, I will hold off on the biopsy for a period of time. That's not necessarily based on hard science, but if they have had anything recently, I just assume it may have altered their normal flora because this does happen," Dr. Wu said.

"So unless the biopsy is really an emergency, I typically hold off, usually about 6 weeks, from the course of antibiotics they may have received for something else. It's prudent to hold off and let their body recover completely before doing a biopsy."