Safety and detailed patterns of morbidity of transrectal ultrasound guided needle biopsy of prostate in a urologist-led unit

BackgroundProstate cancer screening among the general population is highly debatable. Nevertheless, screening among high-risk groups is appealing. Prior data suggests that men carrying mutations in the BRCA1& 2 genes may be at increased risk of developing prostate cancer. Additionally, they appear to develop prostate cancer at a younger age and with a more aggressive course. However, prior studies did not systematically perform prostate biopsies and thus cannot determine the true prevalence of prostate cancer in this population.MethodsThis will be a prospective diagnostic trial of screening for prostate cancer among men with genetic predisposition. The target population is males (40–70 year old) carrying a BRCA1 and/or BRCA2 germ line mutation. They will be identified via our Genetic counseling unit. All men after signing an informed consent will undergo the following tests: PSA, free to total PSA, MRI of prostate and prostate biopsy. The primary endpoint will be to estimate the prevalence, stage and grade of prostate cancer in this population. Additionally, the study aims to estimate the impact of these germ line mutations on benign prostatic hyperplasia. Furthermore, this study aims to create a bio-bank of tissue, urine and serum of this unique cohort for future investigations. Finally, this study will identify an inception cohort for future interventional studies of primary and secondary prevention.DiscussionThe proposed research is highly translational and focuses not only on the clinical results, but on the future specimens that will be used to advance our understanding of prostate cancer patho-physiology. Most importantly, these high-risk germ-line mutation carriers are ideal candidates for primary and secondary prevention initiatives.Trial registrationClinicalTrials.gov: NCT02053805.

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“…• Acute urinary retention – this is very rare (0.1-1% of patients), and usually occurs among elderly subjects [9-11]. …”

Section: Methodsmentioning

confidence: 99%

“…The most common side effects associated with prostatic biopsies are hematospermia, hematuria, fever, hospitalization for prostatitis or urosepsis, and urinary retention [9-11]. Whether the harms of screening are justified by the benefits, in terms of the reported reduction of prostate cancer mortality, is still a very controversial topic.…”

Section: Introductionmentioning

confidence: 99%

Personalized prostate cancer screening among men with high risk genetic predisposition- study protocol for a prospective cohort study

et al. 2014

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Section: E889mentioning

confidence: 99%

“…Another series prospectively evaluated the safety, morbidity, and characteristics of complications for TRUSguided needle biopsy of the prostate in 98 patients solely by urologists at a single unit. 4 Of these patients, 25% patients experienced a rectal bleed post-biopsy.Bleeding post-prostate biopsy occurs in several forms: hematuria (23%-84%), rectal bleeding (17%-45%), and hematospermia (12%-93%), according a white paper on published by the American Urological Association. 5 The incidence of significant bleeding, however, is less wellknown.…”

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confidence: 99%

Intraprostatic hematoma with active bleeding post-prostate biopsy

Guo

So²,

Gray³

2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e888-90. http://dx.doi.org/10.5489/cuaj.2135 Published online November 24, 2014. AbstractTo the best of our knowledge, we report the first known case of a large intraprostatic hematoma with active bleeding following transrectal ultrasound-guided prostate biopsy. Clinical presentationA 63-year-old male presented for transrectal ultrasoundguided (TRUS) prostate biopsy for a serum prostate-specific antigen (PSA) level of 5.0 ng/mL. His surgical history was unremarkable, except for prior transurethral resection of the prostate (TURP) several years ago for benign prostatic hyperplasia (BPH). His medical history included gastroesophageal reflux disease and seizure disorders, for which he was on omeprazole and lamotrigine, respectively.Prior to the procedure, his history, previous imaging, and laboratory results were carefully reviewed. Laboratory values on the morning of the biopsy, including platelet count, international normalized ratio, and partial thromboplastin time were all normal. Informed written consent was obtained after consultation with the patient, and the risks and benefits of the prostatic biopsy were discussed in detail. The patient received a standard dose of peri-procedural antibiotic prophylaxis with ciprofloxacin.The prostatic ultrasound demonstrated a TURP defect, with no other sonographic abnormality. The prostate measured 2.6 × 4.7 × 2.0 cm, with a volume of 18.2 mL and PSA density of 0.27. A spring-loaded 16-gauge core needle biopsy gun was used for the prostate biopsy via a needle guide. A systematic 12-core biopsy was performed. No immediate complications were encountered.Six hours after the biopsy, the patient presented to the local emergency department with severe rectal pain and hypotension. An intravenous contrast enhanced computed tomography of the abdomen and pelvis demonstrated a large hematoma within the prostatic parenchyma with a focus of active contrast extravasation, indicating active ongoing intraprostatic bleeding (Fig. 1, Fig. 2). The prostate was grossly enlarged, with the hematoma/prostate complex measuring 7.9 × 7.3× 12.0 cm.The patient was brought to the interventional suite for emergent angiography and embolization. Flood pelvic aortogram demonstrated a small focus of active contrast pooling within the right prostatic bed, which was confirmed on selective right internal iliac artery angiogram (Fig. 3). A microcatheter was then advanced progressively into a anterior branch of the right internal iliac artery with a series of controlled angiograms. A series of platinum fibered microcoils were deployed across the origin of the bleeding vessel, as well as the adjacent vessel to prevent collateralization (Fig. 4). Post-embolization right internal iliac angiogram demonstrated successful occlusion of the vessel with no further bleeding.We confirmed the diagnosis of large intraprostatic hematoma with active bleeding post-TRUS-guided biopsy of the prostate. DiscussionTo the best of our knowledge, we report the first known large intraprostatic ...

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“…The procedure is relatively safe with few major complications [2,3]. While some have reported that prostate biopsy does not affect lower urinary tract symptoms [4], others have recorded a risk of short-term worsening of voiding dysfunctions after TRUS biopsy [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Voiding Dysfunction After Finger-Guided Prostate Needle Biopsy in Nigerian Men

Adegun¹,

Gbenga²

2017

Med Surg Urol

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Safety and detailed patterns of morbidity of transrectal ultrasound guided needle biopsy of prostate in a urologist-led unit

Abstract: Transrectal ultrasound guided biopsy of the prostate is generally well tolerated with minor pain and morbidity in our urologist-led service. Our data will assist counselling of patients prior to the procedure.

Cited by 25 publications

References 12 publications

Personalized prostate cancer screening among men with high risk genetic predisposition- study protocol for a prospective cohort study

Personalized prostate cancer screening among men with high risk genetic predisposition- study protocol for a prospective cohort study

Intraprostatic hematoma with active bleeding post-prostate biopsy

Prevalence of Voiding Dysfunction After Finger-Guided Prostate Needle Biopsy in Nigerian Men

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