Login to Access Video or Poster Abstract: MP43-03
Sources of Funding: none

Introduction

Despite efforts to mitigate risk, complications after transrectal prostate biopsy remain a dreaded outcome. We assessed whether experiencing a complication associated with diagnostic prostate biopsy influences the decision regarding treatment modality after diagnosis of clinically localized prostate cancer (CaP).

Methods

We identified patients who were diagnosed with low risk (Gleason 6, clinical stage I) or low volume, intermediate risk (Gleason 3+4=7, clinical stage I) CaP following transrectal prostate biopsy in the SEER-Medicare linked database between 2009-2011. Patients experiencing infectious and non-infectious complications within 30 days after biopsy were recorded by ICD-9 diagnosis codes using previously described methods (Loeb, et al. J Urol 2013). We used multivariable logistic regression to determine whether biopsy-associated complications in patients who are eligible for active surveillance (AS) were associated with pursuing AS less commonly than active treatment, including prostatectomy, radiation, cryotherapy, and androgen deprivation.

Results

8932 patients with a diagnosis of low risk or low volume, intermediate risk prostate cancer were included in analysis. Mean age at diagnosis was 71.7 years (± 4.6). 1538 patients (17.2%) experienced complication after prostate biopsy (2.2% infectious complications and 15% non-infectious complications). 1034 patients (11.6%) patients elected to pursue active surveillance while 7898 (88.4%) chose active treatment. On multivariable logistic regression (Figure 1), controlling for demographic and comorbid factors, we determined that experiencing a prostate biopsy-associated complication is associated with a decreased likelihood of choosing active surveillance over active treatment (OR 0.83, 95% CI 0.83-1.00, p<0.05).

Conclusions

Among patients who would be eligible for AS, those who experience a prostate biopsy-associated complication are significantly more likely to seek active treatment. With evidence that men with biopsy-associated complications have neither worse oncologic outcomes nor an increased risk of complications on subsequent biopsies, clinicians should continue to support AS in these men._x000D_ _x000D_

Funding

none