Having More Biopsies Doesn't Cause Extra Complications

Maybe you're a candidate for the Active Surveillance program, and it all sounds ideal for your needs – except for those pesky follow-up biopsies. 

Maybe you're worried that your prostate will turn into a pincushion, and maybe you'll even wind up in the hospital. A lot of men worry about complications from having repeat prostate biopsies. But results from a new Brady study that involved thousands of men are reassuring: "Don't worry, because the risk of complications is very slight," says urologist Edward Schaeffer, M.D., Ph.D., Director of International Urology and Co-Director of the Prostate Cancer Multidisciplinary Clinic. 

In an earlier study of first-time biopsies, Schaeffer and colleagues H. Ballentine Carter, M.D., and Stacy Loeb., M.D. (now at New York University), reported an increased risk of hospitalization that was "attributable specifically to infectious complications," says Schaeffer. The results of this study prompted two things: One was a series of steps to make biopsies safer. "Based on the observations from these studies," he notes, "we worked with infectious disease experts at Hopkins to develop methods to screen for and reduce infectious complications after prostate biopsy." In a rectal exam, Hopkins urologists now routinely screen men for potentially dangerous bacteria before a needle ever touches their prostate: "We check the rectum for resistant bacteria," says Schaeffer, "and if it's present, we can modify the antibiotics a patient takes ahead of time. This makes the biopsy process safer for all men undergoing this procedure."

" We know there are some risks associated 
with prostate biopsy, but this risk does not 
appear to increase with each biopsy."

The other major action that followed this study of first-time biopsies was a much larger study, to assess the risk of complications in men who receive one or more follow-up biopsies. "We looked at more than 13,000 men who underwent a single prostate biopsy, and then we looked at 3,640 men who had multiple prostate biopsies," says Schaeffer, "and examined the frequency of complications between these two groups." 

The investigators found that compared to men who had never had a biopsy, men who underwent repeat prostate biopsies had only a slightly increased risk of hospitalization. "Fortunately, in the men who had additional biopsies there was no greater risk of serious complications (requiring hospitalization) compared to the initial biopsy," Schaeffer says. Carter, who designed and directs the Active Surveillance program, says, "This is an important observation for our patients in Active Surveillance. We know there are some risks associated with prostate biopsy, but this risk does not appear to increase with each biopsy." 

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