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Xia H, Wang H, Chen L, Meng J, Zhou J, Liang C. A New Nomogram Allowing Physicians to Predict Patients at High Risk of Fever Occurring After Prostate Biopsy. Med Sci Monit 2020; 26:e921350. [PMID: 32200388 PMCID: PMC7111130 DOI: 10.12659/msm.921350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background To facilitate early treatment, we constructed a nomogram to predict risk of postoperative fever before prostate biopsy in patients with high risk of fever. Material/Methods We collected information on patients undergoing prostate biopsy from January 2015 to December 2018 from their medical records, including clinical characteristics and laboratory test results. Finally, after strict screening, the prediction model was established in 440 patients who underwent a transrectal prostate biopsy (TRPB). We divided these patients into a training group and validation group at a ratio of 7: 3, respectively. Univariate analysis and multivariate logistic regression analysis were used to select the predictors and to develop the model. Calibration curve and C-index were used to evaluate the accuracy of the nomogram, while DCA was used to assess the clinical value. Results The individualized predictive nomogram contained 3 clinical features – Biopsy-positive rate (BPR), Hematuria, and Urine WBC – significantly associated with post-biopsy fever. The nomogram had good discriminating ability in both the training group and validation group – the C-index was 0.774 (95% CI=0.717–0.832) in the training group and 0.808 (95% CI=0.706–0.909) in the validation group. Hosmer-Lemeshow test proved a good calibration curve fit. The DCA curve suggested that the nomogram would have good clinical utility. Conclusions This is the first study to develop a nomogram to predict fever after prostate biopsy via Biopsy-positive rate (BPR), Hematuria, and Urine WBC. Use of this nomogram might help prevent fever and infection, and could facilitate individualized medical treatment after prostate biopsy.
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Affiliation(s)
- Haoran Xia
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Hui Wang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lei Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Jialin Meng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Jun Zhou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
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2
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Landy R, Houghton LC, Berg CD, Grubb RL, Katki HA, Black A. Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial. Cancer Prev Res (Phila) 2020; 13:367-376. [PMID: 31996370 DOI: 10.1158/1940-6207.capr-19-0397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023]
Abstract
Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (N = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ≥8 and/or stage III/IV) and 15-year risks of prostate cancer-related mortality for men with baseline PSA ≤ 0.5 ng/mL (N = 4,862), ≤1 ng/mL (N = 15,110), and 1.01-2.5 ng/mL (N = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ≤ 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%-0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%-0.12%) for men with PSA ≤ 1 ng/mL, and higher for men with baseline PSA 1.01-2.5 ng/mL (0.51%; 95% CI, 0.38%-0.74%). No men aged ≥65 years with PSA ≤ 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%-0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%-0.53%). Compared with white men, black men with PSA ≤ 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; P < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ≤ 1 ng/mL. Men ages ≥65 years with PSA ≤ 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Lauren C Houghton
- Mailman School of Public Health, Columbia University, New York, New York
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
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3
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Rectal Swabs for Detecting Multidrug Resistant Bacteria Prior to Transrectal Prostate Fusion Biopsy: A Prospective Evaluation of Risk Factor Screening and Microbiologic Findings. Urology 2019; 136:127-132. [PMID: 31705945 DOI: 10.1016/j.urology.2019.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the prevalence of fluoroquinolone resistant (QR) bacteria, multidrug resistant (MDR) bacteria and Enterococcus faecalis (E. faecalis) in rectal swabs of patients undergoing transrectal prostate biopsy and for evaluating if risk factor assessment is reliable for prediction of QR bacteria, MDR bacteria, or E. faecalis. PATIENTS AND METHODS Two hundred consecutive patients received a rectal swab examination prior to transrectal magnetic resonance imaging-guided fusion biopsy, for evaluating the prevalence of QR bacteria, MDR bacteria, and E. faecalis. The results of a standardized risk factor questionnaire, assessing known prognosticators for higher prevalence of resistant bacteria in rectal flora were correlated with the occurrence of QR bacteria, MDR bacteria, and E. faecalis in rectal swabs. RESULTS QR E. coli was detected in 12 patients (6%). Regarding MDR bacteria, extended spectrum β- lactamase- producing E. coli occurred in 8 patients (4%). E. faecalis was found in 15 patients (7.5%). A total of 193 patients completed the risk factor questionnaire. Of those, 107 (53.2%) patients harbored no risk factors, while 86 (42.8%) had at least 1 risk factor, of which the most common was repeat biopsy. No association was found between any risk factor and occurrence of QR bacteria, MDR bacteria, or E. faecalis (P >.05). CONCLUSION The prevalence of resistant germs in our cohort was lower compared to other series. Moreover, the rate of QR bacteria, MDR bacteria, or E. faecalis in rectal swabs was not reliably associated with risk factor assessment.
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Karakonstantis S, Kalemaki D. A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis. Infect Dis (Lond) 2018; 50:791-803. [PMID: 30372643 DOI: 10.1080/23744235.2018.1508882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Infectious complications after transrectal prostate biopsy are rare. Nevertheless, since these are frequent procedures, the burden of infectious complications is high. Considering the increasing antimicrobial resistance, microbiological confirmation is important to guide antimicrobial therapy. METHODS We reviewed PubMed for original studies providing concurrent urine and blood culture data in symptomatic patients with transrectal biopsy-related infectious complications. We performed a proportions meta-analysis (with MedCalc) and calculated the pooled yield of urine and blood cultures and the pooled discordance rate between urine and blood cultures. RESULTS Our review identified 41 studies, involving 852 patients with infectious complications after transrectal prostate biopsy and sufficient data to calculate discordance. The pooled yield of urine cultures was 64.6% (95% CI: 56.2-72.3%, I2 83%), the pooled yield of blood cultures was 43% (95% CI: 36.5-49.7%, I2 74%) and the pooled discordance rate was 14% (95% CI: 10.6-17.8%, I2 53%). In subgroup analyses the pooled discordance was; 19.6% (95% CI: 11.8-28.9%, I2 31%) in 113 patients presenting within 2 calendar days after the biopsy and 11.2% (95% CI: 4.5-20%, I2 47%) in 143 patients presenting with fever and symptoms of lower urinary tract symptoms. The statistical and methodological heterogeneity of included studies was high. CONCLUSION Obtaining blood cultures is reasonable in all patients presenting with systemic symptoms suggestive of infection after a transrectal prostate biopsy. Blood cultures can provide additional microbiological data in about 1 of 7 patients with post-biopsy infectious complications. Prospective studies are needed to validate these results.
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Affiliation(s)
- Stamatis Karakonstantis
- a 2nd Department of Internal Medicine, General Hospital of Heraklion "Venizeleio-Pananeio" , Heraklion , Greece
| | - Dimitra Kalemaki
- b General Medicine, University Hospital of Heraklion , Heraklion , Greece
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Haldrup C, Pedersen AL, Øgaard N, Strand SH, Høyer S, Borre M, Ørntoft TF, Sørensen KD. Biomarker potential of ST6GALNAC3 and ZNF660 promoter hypermethylation in prostate cancer tissue and liquid biopsies. Mol Oncol 2018; 12:545-560. [PMID: 29465788 PMCID: PMC5891052 DOI: 10.1002/1878-0261.12183] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/17/2017] [Accepted: 02/14/2018] [Indexed: 01/04/2023] Open
Abstract
Current diagnostic and prognostic tools for prostate cancer (PC) are suboptimal, leading to overdiagnosis and overtreatment. Aberrant promoter hypermethylation of specific genes has been suggested as novel candidate biomarkers for PC that may improve diagnosis and prognosis. We here analyzed ST6GALNAC3 and ZNF660 promoter methylation in prostate tissues, and ST6GALNAC3,ZNF660,CCDC181, and HAPLN3 promoter methylation in liquid biopsies. First, using four independent patient sample sets, including a total of 110 nonmalignant (NM) and 705 PC tissue samples, analyzed by methylation‐specific qPCR or methylation array, we found that hypermethylation of ST6GALNAC3 and ZNF660 was highly cancer‐specific with areas under the curve (AUC) of receiver operating characteristic (ROC) curve analysis of 0.917–0.995 and 0.846–0.903, respectively. Furthermore, ZNF660 hypermethylation was significantly associated with biochemical recurrence in two radical prostatectomy (RP) cohorts of 158 and 392 patients and remained significant also in the subsets of patients with Gleason score ≤7 (univariate Cox regression and log‐rank tests, P < 0.05), suggesting that ZNF660 methylation analysis can potentially help to stratify low‐/intermediate‐grade PCs into indolent vs. more aggressive subtypes. Notably, ZNF660 hypermethylation was also significantly associated with poor overall and PC‐specific survival in the RP cohort (n = 158) with long clinical follow‐up available. Moreover, as proof of principle, we successfully detected highly PC‐specific hypermethylated circulating tumor DNA (ctDNA) for ST6GALNAC3,ZNF660,HAPLN3, and CCDC181 in liquid biopsies (serum) from 27 patients with PC vs. 10 patients with BPH, using droplet digital methylation‐specific PCR analysis. Finally, we generated a three‐gene (ST6GALNAC3/CCDC181/HAPLN3) ctDNA hypermethylation model, which detected PC with 100% specificity and 67% sensitivity. In conclusion, we here for the first time demonstrate diagnostic biomarker potential of ST6GALNAC3 and ZNF660 methylation, as well as prognostic biomarker potential of ZNF660. Furthermore, we show that hypermethylation of four genes can be detected in ctDNA in liquid biopsies (serum) from patients with PC.
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Affiliation(s)
- Christa Haldrup
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | - Anne L Pedersen
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | - Nadia Øgaard
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | - Siri H Strand
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | - Søren Høyer
- Department of Histopathology, Aarhus University Hospital, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Denmark
| | - Torben F Ørntoft
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | - Karina D Sørensen
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
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Woldu SL, Hutchinson RC, Singla N, Hornberger B, Roehrborn CG, Lotan Y. Prospective Monitoring and Adapting Strategies for Prevention of Infection Following Transrectal Prostate Procedures. UROLOGY PRACTICE 2018; 5:124-131. [DOI: 10.1016/j.urpr.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Solomon L. Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan C. Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brad Hornberger
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Claus G. Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Cataldo MA, Granata G, Petrosillo N. Antibacterial Prophylaxis for Surgical Site Infection in the Elderly: Practical Application. Drugs Aging 2017; 34:489-498. [PMID: 28589466 DOI: 10.1007/s40266-017-0471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgical site infections are among the most common healthcare-associated infections and are linked with increased length of hospitalization, re-admission, mortality and significant financial burden. Risk factors for the occurrence of surgical site infections include variables related to the surgical procedure as well as host factors. Increasing age is associated with the occurrence of surgical site infections. The aim of this review is to give an update on the antibiotic prophylaxis for surgical site infection in elderly people. We focused on specific issues and practical applications, such as the importance of targeting the antimicrobial agent to the susceptibility pattern of colonizing flora in selected cases and the need for dosage modifications.
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Affiliation(s)
- Maria Adriana Cataldo
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy
| | - Guido Granata
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy
| | - Nicola Petrosillo
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy.
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8
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AlKhateeb SS, AlShammari NA, AlZughaibi MA, Ghazwani YG, Alrabeeah KA, Albqami NM. The prevalence of urinary tract infection, or urosepsis following transrectal ultrasound-guided prostate biopsy in a subset of the Saudi population and patterns of susceptibility to flouroquinolones. Saudi Med J 2017; 37:860-3. [PMID: 27464862 PMCID: PMC5018702 DOI: 10.15537/smj.2016.8.15803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives: To study the prevalence of urinary tract infections (UTI), or sepsis secondary to trans-rectal ultrasound-guided (TRUS) biopsy of the prostate, the pathogens involved, and patterns of antibiotic resistance in a cohort of patients. Methods: This is a descriptive study of a consecutive cohort of patients who underwent elective TRUS biopsy at King Abdulaziz Medical City Riyadh, Saudi Arabia between January 2012 and December 2014. All patients who underwent the TRUS guided prostate biopsy were prescribed the standard prophylactic antibiotics. Variables included were patients’ demographics, type of antibiotic prophylaxis, results of biopsy, the rate of UTI, and urosepsis with the type of pathogen(s) involved and its/their antimicrobial sensitivity. Results: Simple descriptive statistics were used in a total of 139 consecutive patients. Urosepsis requiring hospital admission was encountered in 7 (5%) patients and uncomplicated UTI was observed in 4 (2.8%). The most common pathogens were Escherichia coli (90.1%) and Klebsiella pneumoniae (9.1%). Resistance to the routinely used prophylaxis (ciprofloxacin) was observed in 10 of these patients (90.9%). Conclusion: This showed an increase in the rate of infectious complications after TRUS prostate biopsy. Ciprofloxacin resistance was found in 90.9% of patients with no sepsis.
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Affiliation(s)
- Sultan S AlKhateeb
- Department of Urology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Abstract
Zinc has long been the focus of many biological investigations because of its essential role in biology including a catalytic role in many enzymes, a structural role in the many zinc finger proteins, and a physiological role in many secretory cell processes. Divalent zinc is known to be highly abundant in healthy prostate tissues and lower in prostate cancer (PCa). Given the need for newer diagnostic methods for detection of prostate cancer, zinc-responsive probes of various types have been considered as imaging tools for detecting tissue levels of zinc. Among them, recent zinc-responsive MRI probes show great promise for non-invasive detection of zinc ion secretion from the prostate and other tissues in vivo. In this review, we summarize the need for new diagnostic tools and demonstrate how responsive zinc probes and MRI could satisfy this unmet need.
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Affiliation(s)
- Su-Tang Lo
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8568
| | - André F Martins
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8568
- Department of Chemistry, University of Texas at Dallas, Richardson, TX 75083
| | - Veronica Clavijo Jordan
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8568
| | - A Dean Sherry
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8568
- Department of Chemistry, University of Texas at Dallas, Richardson, TX 75083
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10
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The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature. Infect Dis Health 2017; 22:117-128. [DOI: 10.1016/j.idh.2017.07.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
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11
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Grummet J, Pepdjonovic L, Huang S, Anderson E, Hadaschik B. Transperineal vs. transrectal biopsy in MRI targeting. Transl Androl Urol 2017; 6:368-375. [PMID: 28725578 PMCID: PMC5503965 DOI: 10.21037/tau.2017.03.58] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Prostate biopsy is typically performed via either the transrectal or transperineal approach. MRI-targeted biopsy, whether using any of the three options of cognitive fusion, MRI-ultrasound fusion software, or in-bore MRI-guided biopsy, can also be performed via either transrectal or transperineal approaches. As an extension of traditional random prostate biopsy, the transrectal approach is far more commonly used for MRI-targeted biopsy due to its convenience. However, in the context of today’s increasing multi-drug resistance of rectal flora, the transperineal approach is being used more often due to its lack of septic complications. In addition, only a first-generation cephalosporin, not a fluoroquinolone, is required as antibiotic prophylaxis. Evidence shows excellent detection rates of significant prostate cancer using magnetic resonance imaging (MRI)-targeted and/or systematic transperineal biopsy (TPB). However, there are no head-to-head studies comparing the different MRI-targeted methods within TPB. To provide truly patient-centred care, the biopsy technique using the safest method with the highest detection rate of significant cancer should be used. Depending on healthcare context and hospital resource utilization, MRI-targeted TPB is an excellent option and should be performed wherever available and feasible. Whilst building capacity for TPB in one’s practice, the routine use of rectal culture swabs prior to any transrectal biopsies is strongly encouraged. Independent of biopsy route, the addition of systematic cores needs to be discussed with the patient weighing maximal detection of significant cancer against increased detection of insignificant lesions.
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Affiliation(s)
- Jeremy Grummet
- Australian Urology Associates, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | | | - Sean Huang
- Australian Urology Associates, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Elliot Anderson
- Australian Urology Associates, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
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12
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Togo Y, Yamamoto S. Prevention of infectious complications after prostate biopsy procedure. Int J Urol 2017; 24:486-492. [PMID: 28556409 DOI: 10.1111/iju.13369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
Although febrile complications are rarely encountered after a prostate biopsy procedure, in recent years the number of cases of fatal infection after that have increased along with increases in resistant bacteria. The available biopsy approaches are transrectal and transperineal, with the transrectal approach primarily used. As the invasion path of the puncture needle differs between these approaches, pretreatment and the method of administration of preventive antimicrobial drugs should be separately considered for infection prevention. Recently, the Japanese guidelines for perioperative infection prevention in the field of urology were revised after receiving approval from the Japanese Urological Association. With use of the transrectal approach, attempts have been made to selectively administer prophylactic antibiotics by confirming the presence or absence of resistant bacteria in rectal swab culture results before carrying out a prostate biopsy procedure because of potential problems associated with resistant bacteria in rectal flora. For preventive antibiotics, a single dose of oral quinolone is recommended for patients with low risk, whereas daily administrations of piperacillin/tazobactam are recommended for those considered to be high risk. In contrast, for the transperineal procedure, a single dose of oral quinolone is recommended as a preventive antibiotic. With both approaches, it is important to empirically administer broad-spectrum antimicrobials when occurrence of a febrile infection after a prostate biopsy procedure is confirmed.
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Affiliation(s)
- Yoshikazu Togo
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Prostate Biopsy-related Infection: A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches. Urology 2016; 104:11-21. [PMID: 28007492 DOI: 10.1016/j.urology.2016.12.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022]
Abstract
A systematic review to identify risk factors for prostate biopsy-related infection, preventative strategies, and optimal management of infectious complications was conducted. Significant risk factors for postbiopsy infection include urogenital infection, antibiotic use, international travel, hospital exposure, bacteriuria, previous transrectal biopsy, and resistance of fecal flora to antibiotic prophylaxis (especially fluoroquinolones). Patients at risk may benefit from an adjusted biopsy protocol comprising transrectal biopsy under targeted prophylaxis, and/or the use of rectal disinfection techniques or using a transperineal approach. Management of biopsy-related infection should be based on individual risk and local resistance profiles with input from multiple specialties.
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Chamberland RR. Cutting to the Core of the Issue: Emerging Strategies To Reduce Prostate Biopsy-Related Infections. J Clin Microbiol 2016; 54:2431-5. [PMID: 27147719 PMCID: PMC5035433 DOI: 10.1128/jcm.00144-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Over 1 million men undergo biopsy in the United States each year to evaluate for prostate cancer (S. Loeb, H. B. Carter, S. I. Berndt, W. Ricker, and E. M. Schaeffer, J Urol 186:1830-1834, 2011, http://dx.doi.org/10.1016/j.juro.2011.06.057). In recent years, there has been a rise in infectious complications related to these procedures. This review aims to provide an overview of the guidelines that direct transrectal prostate biopsy, to describe associated infection, and to evaluate the published data driving the current trend toward prebiopsy screening for resistant organisms.
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Affiliation(s)
- Robin R Chamberland
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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