Transperineal prostate biopsy shows core–complication connection
medwireNews: Research shows that clinical complications after transperineal prostate biopsy are common, but rarely result in hospital admission.
And, the risk for side effects significantly increases with the number of needle cores taken, report Pietro Pepe and Francesco Aragona from Cannizzaro Hospital in Catania, Italy.
The study, published in Urology, included 3000 Caucasian men, aged a median of 66 years, who underwent transperineal prostate biopsy following an abnormal rectal examination or prostate-specific antigen test. Overall, 1150 (38.3%) men were found to have prostate cancer.
The overall rate of side effects was 40.2%, with 37 (1.2%) men requiring hospital admission, and 274 (9.1%) attending the emergency department.
The authors found that the rate of complications directly correlated with the number of needle cores, such that the rate was 31.5% in patients undergoing 12 cores, 41.8% in patients undergoing 18, and 57.4% in those who underwent more than 24 (saturation biopsy).
The rate of hospital admissions and emergency department visits also increased with increasing numbers of needle cores, although this was not statistically significant.
The most common reason for needing hospital recovery was urinary tract infection with fever, which occurred in 56.7% of patients admitted to hospital. But for emergency department visits, the most common reason was acute urinary retention, occurring in 6.7% of patients overall.
Of the individual complications, only hemospermia was significantly associated with the number of needle cores, reported in 30.4% of patients who underwent saturation biopsy and 10.7% of patients with 12 cores.
The rate of complications associated with the more commonly used transrectal ultrasound-guided prostate biopsy has increased over the previous decade following an increase in the number of needle cores, use of antiplatelet agents, and infections, explain the authors.
It has been suggested that, although less effective, transperineal prostate biopsy could be useful to reduce the rate of infections. However, limited data have been available to guide this decision.
"To our knowledge, this series is the first to evaluate transperineal prostate biopsy in such a high number of patients," comment the authors.
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By Kirsty Oswald, medwireNews Reporter