Death from Biopsy

Frequently we may urge a newcomer to proceed to biopsy, "it's no big deal", "it's the only way to tell for sure", etc. Sometimes that's not the case.

One of my tennis partners has a close friend who just died as a result of complications from his prostate biopsy Picture this...hale and hearty 70 year old man whose PSA has always been reasonably low, i.e. under 4. His most recent PSA test showed a sudden one time spike to double digits. Rather than the oft recommended course of antibiotics he and/or his doctor went into panic mode and decided that they needed to "know for sure" whether or not prostate cancer was present.

Unfortunately, something went terribly awry during the process, the patient developed sepsis, his organs shut down over the course of a week and he just passed away.

I don't tell this story to scare patients away from biopsies...most of us had them and for good reason. However, ANY medical procedure has its' risks and I guess we should all be a little cautious and make sure we are educated about the reasons for the procedure, the alternatives and the potential outcomes before we pull the trigger.

Oh...the results from the biopsy were negative...no PCa found...

Jim

I'm glad you posted this. Biopsies are a useful tool but should only be used when symptoms warrant. Side-effects are usually relatively minor but there are always side-effects. It stands to reason that the more samples taken the greater potential side-effects or problems. I often cringe when I hear a new member, with very minor symptoms, being encouraged by a urologist to get either a saturation biopsy or to get another biopsy a couple of months after the first one came up with a negative result.

Couldn't agree more

Great story, Tud, I am sure there is always that rare exception, its a shame this happened. But as said, I wouldn't want someone in true need of a biopsy to be scared off.

Just like with my radiation damage, rare, absolutely, but obviously it happens. That's why I keep harping to men, to make sure they really need to pull the trigger, because by doing so, they are exposing themselves to a lot of potential risks and problems, so you sure wouldn't want to unless there was clear evidence of BCR.

In the case of your story, the doctor should have ran a course of antibiotics first, especially considering the man's PSA history and age.

David

Sorry to hear about this...and especially since he didn't have PC.

Just to give some numbers of how often this can occur:

Trans-rectal ultrasound guided biopsy of the prostate represents the diagnostic standard for prostate cancer, but its mortality rate has never been examined. We performed a population-based study of 120-day mortality after prostate biopsy in 22,175 patients, who underwent prostate biopsy between 1989 and 2000. The control group consisted of 1,778 men aged 65-85 years (median 69.5), who did not undergo a biopsy. Univariable and multivariable logistic regression analyses were performed in 11,087 of 22,175 (50%) men subjected to prostate biopsy, to identify predictors of 120-day mortality. Variables were age at biopsy, baseline Charlson comorbidity index and cumulative number of biopsy procedures. We externally validated the model's predictors in the remaining 50% of men. Overall 120-day mortality after biopsy was 1.3% versus 0.3% (p < 0.001) in the control group. Of men aged < or = 60 years, 0.2% died within 120 days versus 2.5% aged 76-80. Zero Charlson comorbidity score yielded 0.7% mortality versus 2.2%, if 3-4. First ever biopsy procedures carried a higher mortality risk than subsequent procedures (1.4 vs. 0.8 vs. 0.6%). In the multivariable model, first ever biopsy, increasing age and comorbidity predicted higher mortality. Overall, the model's variables were 79% accurate in predicting the probability of 120-day mortality after biopsy. In conclusion, our data suggest that prostate biopsy might predispose to higher mortality rate. The certainty of this association remains to be proven.

http://www.ncbi.nlm.nih.gov/pubmed/18470914

 

Good info Jerry,
We will do a service to all by pointing out these risks to which most patients are not aware of. Biopsies should be the last resort, not the first tool in a doctor's bag. and we should be careful in recommending biopsies to new patients before other less invasive methods are used first to eliminate other natural causes of high psa. The 750,000 annual negative biopsies should be a warning that the majority of biopsies are unnecessary.

Terrible outcome that's for sure, but I could use a little further clarification. I understand that if a biopsy is performed due to a rising PSA, giving antibiotics beforehand to rule out any infection in the prostate that could account for the increase in PSA is frequently done by Uros. But is it customary for the Uro to start a course of antibiotics prior to the biopsy to prevent infection FROM the biopsy?

Jim,

Thanks for that cautionary story. Too often biopsies are rushed into before other more common sources of elevated PSA are ruled out.

Of particular concern are fluoroquinoline-resistant e. coli, which is becoming increasingly common. In a recent study, 22% of men harbor such resistant bacteria, and about 3% of men who have a biopsy require hospitalization due to such infection. Since less than a third of men undergoing biopsy test positive for PC, and most of those will have insignificant, indolent disease, this is a troubling risk/benefit ratio.

I am glad the trend is towards decreased frequency of biopsy with AS. A less dangerous biopsy route is transperineal because fecal matter is not injected into the prostate.

- Allen