Risk of hospitalization and death following prostate biopsy in Scotland

- There are limited data on adverse effects of prostate biopsy in real world settings.
- Substantial numbers of elderly men in Scotland undergo prostate biopsy.
- Higher rates of adverse events occur in older patients and those with co-morbidity.
- There is probably scope to improve patient selection for prostate biopsy.
- Efforts to reduce the risk of complications of prostate biopsy should be maintained.

ObjectiveTo investigate the risk of hospitalization and death following prostate biopsy.Study designRetrospective cohort study.MethodsOur study population comprised 10,285 patients with a record of first ever prostate biopsy between 2009 and 2013 on computerized acute hospital discharge or outpatient records covering Scotland. Using the general population as a comparison group, expected numbers of admissions/deaths were derived by applying age-, sex-, deprivation category-, and calendar year-specific rates of hospital admissions/deaths to the study population. Indirectly standardized hospital admission ratios (SHRs) and mortality ratios (SMRs) were calculated by dividing the observed numbers of admissions/deaths by expected numbers.ResultsCompared with background rates, patients were more likely to be admitted to hospital within 30 days (SHR 2.7; 95% confidence interval 2.4, 2.9) and 120 days (SHR 4.0; 3.8, 4.1) of biopsy. Patients with prior co-morbidity had higher SHRs. The risk of death within 30 days of biopsy was not increased significantly (SMR 1.6; 0.9, 2.7), but within 120 days, the risk of death was significantly higher than expected (SMR 1.9; 1.5, 2.4). The risk of death increased with age and tended to be higher among patients with prior co-morbidity. Overall risks of hospitalization and of death up to 120 days were increased both in men diagnosed and those not diagnosed with prostate cancer.ConclusionsHigher rates of adverse events in older patients and patients with prior co-morbidity emphasizes the need for careful patient selection for prostate biopsy and justifies ongoing efforts to minimize the risk of complications.