Department of Urology, New York University, New York, NY, USA.
Eur Urol. 2012 Jun;61(6):1110-4. doi: 10.1016/j.eururo.2011.12.058. Epub 2012 Jan 5.
The complications of prostate needle biopsy (PNB) are important when considering the benefits and harms of prostate cancer screening. Studies from the United States and Canada have recently reported increasing numbers of hospitalizations for infectious complications after PNB.
Examine the risk of infectious complications and hospital admissions after PNB in a European screening trial.
DESIGN, SETTING, AND PARTICIPANTS: From 1993 to 2011, 10 474 PNBs were performed in the European Randomized Study of Screening for Prostate Cancer (Rotterdam section). Prophylaxis originally consisted of trimethoprim-sulfamethoxazole. Beginning in 2008, it was changed to ciprofloxacin.
Febrile complications and hospital admissions were assessed by questionnaires 2 wk after PNB. Logistic regression was used to identify risk factors for biopsy-related fever and hospital admission.
Fever and hospital admission were reported on 392 of 9241 questionnaires (4.2%) and 78 of 9198 questionnaires (0.8%), respectively. Although most fevers were managed on an outpatient basis, 81% of hospital admissions were for infection. Of the 56 available blood cultures, 34 were positive with Escherichia coli as the predominant organism. On multivariable analysis, prostate enlargement and diabetes were significantly associated with an increased risk of fever after PNB, whereas later year of biopsy was the only factor significantly associated with an increased risk of hospital admission.
In a European screening trial, <5% PNBs resulted in febrile complications. Significant risk factors included diabetes and prostatic enlargement. Although most fevers were managed on an outpatient basis, infection remained the leading cause of hospital admission after PNB. Consistent with prior international reports, the frequency of hospital admissions after PNB significantly increased over time. Nevertheless, the absolute frequency of hospital admissions related to PNB was low and should not dissuade healthy men who would benefit from early prostate cancer diagnosis from undergoing biopsy when clinically indicated.
在考虑前列腺癌筛查的获益和危害时，前列腺穿刺活检（PNB）的并发症非常重要。美国和加拿大的研究最近报告称，PNB 后感染性并发症的住院人数不断增加。
在一项欧洲筛查试验中，研究 PNB 后感染性并发症和住院的风险。
设计、地点和参与者：1993 年至 2011 年，在欧洲前列腺癌筛查随机研究（鹿特丹部分）中进行了 10474 例 PNB。最初的预防措施包括复方磺胺甲噁唑。从 2008 年开始，改为环丙沙星。
PNB 后 2 周通过问卷评估发热性并发症和住院情况。使用逻辑回归确定与活检相关发热和住院的危险因素。
在 9241 份问卷中有 392 份（4.2%）和 9198 份问卷中有 78 份（0.8%）报告了发热和住院。尽管大多数发热患者在门诊治疗，但 81%的住院患者是因感染。在 56 份可进行血液培养的样本中，有 34 份呈阳性，主要病原体为大肠杆菌。多变量分析显示，前列腺增大和糖尿病与 PNB 后发热风险增加显著相关，而活检的年份是与住院风险增加唯一显著相关的因素。
在一项欧洲筛查试验中，<5%的 PNB 导致发热性并发症。显著的危险因素包括糖尿病和前列腺增大。尽管大多数发热患者在门诊治疗，但感染仍然是 PNB 后住院的主要原因。与之前的国际报告一致，PNB 后住院人数随着时间的推移显著增加。然而，与 PNB 相关的住院人数绝对较少，不应劝阻可能从早期前列腺癌诊断中获益的健康男性在临床需要时进行活检。
