Objective• To determine the rate of hospital re-admission for sepsis after transperineal (TP) biopsy using both local data and worldwide literature, as there is growing interest in TP biopsy as an alternative to transrectal ultrasonography (TRUS)-guided biopsy for patients undergoing repeat prostate biopsy. Patients and Methods• Pooled prospective databases on TP biopsy from multiple centres in Melbourne were queried for rates of re-admission for infection.• A literature review of PubMed and Embase was also conducted using the search terms: 'prostate biopsy, fever, infection, sepsis, septicaemia and complications' . Results• In all, 245 TP biopsies were performed (111 at Alfred Health, 92 at Epworth Healthcare, 38 at Peter MacCallum Cancer Centre, and four at other institutions).• The rate of hospital re-admission for infection was zero.• The literature review showed that the rate of sepsis after TRUS biopsy appears to be rising with increasing rates of multi-resistant bacteria found in rectal flora, and is as high as 5%.• However, the rate of sepsis from published series of TP biopsy approached zero. Conclusions• Both local and international data suggest a negligible rate of sepsis with TP biopsy.• This compares to a concerning rise in the rate of sepsis after TRUS biopsy due to the increasing prevalence of multi-resistant bacteria in rectal flora.• Although TRUS biopsy is convenient, cheap and quick to perform, we think that TP biopsy should now be offered as an option, not only to patients undergoing repeat prostate biopsy, but to all patients in whom a prostate biopsy is indicated.
In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic. Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels <10 ng/ml, biopsy Gleason scores of 6 or less, a maximum of one or two tumour-positive biopsy core samples and/or a maximum of 50% of cancer per core sample. Following initiation of an AS programme, most guidelines recommend serial serum PSA measurements, digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed.
ObjectivesTo ascertain the treatment trends and patterns of care, for men with prostate cancer on active surveillance (AS) in Victoria, Australia. Patients and MethodsDe-identified data was obtained for 6424 men from the Victorian Prostate Cancer Registry. Men included in this study were diagnosed with prostate cancer from 2008 to August 2012 with ≥12-months of follow-up. Patients were stratified using the National Comprehensive Cancer Network (NCCN) risk grouping system and those who were not actively treated were identified. Data was acquired to describe the trends and uptake of AS according to public vs private hospital sector, and regional vs metropolitan regions. ResultsIn all, 1603/6424 (24.9%) men received no treatment with curative intent at 12-months follow-up. This cohort included patients in whom the chosen management plan was recorded as AS (980/ Of these, 202/652 (30.9%) of the AS patients with very low-/low-risk disease were managed in the public sector, vs 450/652 (69%) of very low-/low-risk AS patients being managed in the private sector. In our cohort, patients with very low-and low-risk disease, managed in a private hospital, were more likely to be on AS (P = 0.005). AS patients in the private sector were also a median of 2.8 years younger (median 65.6 vs 68.4 years, P < 0.001); had a lower median PSA level (5.3 vs 6.7 ng/mL, P < 0.001); and had lower biopsy Gleason score and clinical staging. There was no significant difference in the uptake of AS demographically, in our cohort of men between metropolitan and regional areas. ConclusionIn this contemporary registry-based population, AS is being used in a significant proportion of patients. The proportion of men progressing to intervention is lower than that reported in the current literature. Patients are more likely to be on AS if they are managed in a private hospital, with no differences in the uptake of AS, from metropolitan to regional areas.
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