Michael Liss, MD
Michael Liss, MD, principal investigator at SWOG (formerly Southwest Oncology Group) and medical director for clinical research, University of Texas Health Science Center, San Antonio.
More than one million US men get prostate biopsies every year. The procedure is simple—but, unfortunately, it is increasingly being followed by complications that can be serious…and even life-threatening. What you need to know…
While a prostate biopsy is an easy procedure, it has a high potential for infection. That’s because prostate tissue samples are taken by needle punctures made through the rectum. E. coli bacteria are part of the natural environment of the rectum and can easily attach to the biopsy needles and infect the prostate, causing serious infection.
For this reason, prostate biopsy patients are given the antibiotic ciprofloxacin (Cipro) prophylactically to protect against prostate infections—and for years that worked. Now, however, with the rise of antibiotic resistance, about 10% to 20% of people have Cipro-
resistant E. coli bacteria in their rectums, increasing risk for prostate infection from biopsy fourfold.
Some urologists try to reduce infection risk by cleaning biopsy needles after each needle puncture (typically 12 or more for each biopsy), cleaning the rectal area with a disinfectant before the procedure and/or giving extra antibiotics. Studies have not confirmed the effectiveness of these strategies.
Avoiding prostate infection from biopsies is challenging but not impossible. These strategies are showing effectiveness…
Determine if rectal E. coli are Cipro-resistant by doing a rectal swab culture several days before the biopsy. If that is the case, a different antibiotic—for instance, an injection of a broad-spectrum antibiotic—can be given about one hour before the biopsy to kill off the E. coli bacteria. (Adding antibiotics also carries risk, including more antibiotic resistance and antibiotic-associated diarrhea.)
You may want to consider having a rectal swab if you are at high risk for Cipro-resistance. Risk factors include:
However, Cipro-resistance isn’t the only thing that raises risk for prostate biopsy infections. Men are also at higher risk if they have diabetes…take steroids…are undergoing chemotherapy…and/or have a recent history of prostatitis or urinary tract infection.
Take a safer route to the biopsy. A procedure called transperineal prostate biopsy takes prostate tissue samples through the skin between the anus and scrotum (perineum). Transperineal prostate biopsy has a lower infection rate (less than 1% compared with 5% to 7%) than traditional prostate biopsy, but is not routinely performed. It is usually done in an operating room under general anesthesia and has a higher rate of temporary urinary retention (inability to urinate) after the procedure. It is also much more expensive than traditional prostate biopsy and may or may not be covered by insurance.
Alert your doctor immediately to any signs of infection. Infections can quickly become severe and may require a hospital stay and intravenous antibiotics. Symptoms to look for include chills, fever and urine that burns or is difficult to pass. The American Urological Association recommends that patients with fever post-biopsy be assessed for sepsis, a potentially life-threatening blood infection, and not be given a fluoroquinolone antibiotic, such as Cipro or levofloxacin (Levaquin), or trimethoprim-sulfamethoxazole (Bactrim), all of which are likely to be ineffective because of antibiotic resistance.
If you’re scheduled for a prostate biopsy, ask your urologist about his/her infection rate and what he does to lower risk.
