Well over a million U.S. men are thought to get prostate biopsies every year — a test that involves firing needles into a man's prostate gland from a probe stuck into his backside.
For the vast majority, the test isn't fun, but it's not dangerous.
But specialists are worrying about an increasing risk of complications from prostate biopsy, especially hard-to-treat bloodstream infections that can send men to the ICU and require weeks of heavy-duty antibiotic treatment.
Chicago attorney Tom Hayward is an example. His biopsy wasn't as painful as he expected, and the next day, he played tennis and worked a full day. But at the end of the day, something odd and alarming happened after he started out for a dinner engagement.
"From that point forward, for about an hour, I can't tell you how I got where I did, except I was on ... the three busiest expressways in Chicago," Hayward says.
A 'Dramatic Change' In Mental Status
When Hayward didn't show up for dinner, his wife got concerned. Police located his car because it had an onboard navigational system. By that point, Hayward had realized he was way off-course.
"Fifteen minutes later, one of my sons, who's a lawyer here in town, pulled me over and said, 'Give me the keys,' " Hayward says. "He called an ambulance and took me to a local hospital."
Hayward's urologist, Dr. Anthony Schaeffer, says he suffered a raging infection caused by bacteria present in his gut before the biopsy. The biopsy introduced the bugs into Hayward's bloodstream.
Schaeffer says this kind of bloodstream infection can cause "a very sudden and dramatic change in [mental] status."
Doctors all over the world are increasingly concerned about post-biopsy infections. At last week's annual meeting of the American Urological Association, there were 10 reports on the phenomenon.
"It's a growing problem, and people are recognizing it," says Dr. Robert Nam of the University of Toronto.
He led a study, published last year in the Journal of Urology, that documents a steady increase in infections serious enough to require hospitalization among all Ontario men undergoing prostate biopsies.
A Dramatic Rise In Infections
"The rate went from 1 percent to 4 percent," Nam says. "That's a huge increase. A fourfold increase over a 10-year period in hospital admission rates for a diagnostic procedure is high, very high — concerningly high."
It may not sound like a lot, but applied to a million men undergoing prostate biopsies, it suggests 40,000 could be suffering serious infections, if the Ontario data are any guide.
A recent U.S. study, conducted by Johns Hopkins researchers on records of more than 150,000 Medicare patients, found that 7 percent suffer serious complications requiring hospital care within 30 days after prostate biopsy.
Only a fraction of these are infections — about four in 1,000, or a tenth of the Ontario sample. But Dr. Stacy Loeb, who led the study, notes that the rate of serious infections has been going up sharply over the past decade, while noninfectious complications have been flat.
"Compared to a control group of men who did not undergo prostate biopsy, patients who had a prostate biopsy had almost a threefold increased risk of hospitalization," Loeb says, "and a substantially increased risk of hospitalization for infection."
She says nonwhite men had twice the infection risk as whites.
The underlying problem, many say, is the spread of antibiotic-resistant microbes.
"Unfortunately, there's been a rise of bugs that are resistant to our antibiotics," Loeb says. "So even though they're given to try to prevent infection, they may not work in that situation."
Urologists typically give men an everyday antibiotic such as ciprofloxacin to take before and after a biopsy to reduce the infection risk.
Killing The Bugs To Prevent Infections
Prostate biopsy inherently poses a risk of infection because the needles that grab a tiny piece of prostate tissue can transport bacteria through the rectal wall into the prostate and bloodstream.
Specialists are trying to figure out how to prevent biopsy-related infections.
Schaeffer, the Northwestern University urologist who performed attorney Tom Hayward's biopsy, co-authored a study presented last week on a method that he says has reduced his hospital's post-biopsy infection rate to zero.
It involves checking a man's intestinal tract to see if he harbors resistant bacteria and giving him the most effective antibiotics — before his biopsy.
"The point is that this directed preventive therapy is designed to kill the bugs that are there, versus just guessing as to what bugs might be there," Schaeffer says.
Meanwhile, his Northwestern colleague, Robert Nadler, says the infection risk is causing a lot of soul-searching about prostate biopsies.
"This is forcing urologists to really step back and take a look and say, 'Does this patient really need a biopsy?' " Nadler says.
By the way, you might be wondering if Tom Hayward's biopsy discovered cancer.
"Fortunately negative," Hayward reports. "The good news is the biopsies were negative. The bad news is the end result almost put me in the ground."
But Hayward wouldn't hesitate to get another biopsy if his doctor told him to. Next time, though, he would be on guard for any fever afterward.