INTRODUCTION AND OBJECTIVES

In an effort to design a research study for prostate biopsy prophylaxis, we needed a protocol that would be accepted by most urologists. Our goal was to assess the practice pattern for prostate biopsy prophylaxis in order to tailor a study that urologists would agree to participate in.

METHODS

A questionnaire was designed to assess how urologists perform prostate biopsies. An anonymous online survey was sent to 3363 urologists using Survey Monkey. Descriptive statistics were performed.

RESULTS

235 urologists completed the survey, corresponding to a 7% response rate. 43% of the urologists do 10-15 prostate biopsies a month, with the majority (71%) taking 10-12cores during each biopsy.

Only 73% routinely obtain a urinalysis before biopsy. Rectal enema is the preferred prep, used by over 86% of urologist. Most (76%) prefer it done the morning of procedure.

Fluoroquinolones are used by 88% of respondents. Most (63%) start antibiotics the night before procedure while others begin 2hours (22%) or 30minutes (16%) before. Post biopsy, 5% give a single dose fluoroquinolone, 27% continue for 24hours, 35% for 48hours, and 33% for 72hours. While there are urologists who will not give post procedure antibiotics, there are those who will continue antibiotics for even up to a week. Aminoglycosides are the most popular IV/IM antibiotics, generally given as a single agent or in combination with oral agents.

67% of urologists report having had patients hospitalized for post-biopsy complications. While the majority (75%) only have 1-2 patients hospitalized every year, a minority (1%) see as many as 8-10 patients hospitalized yearly. 41% of urologists report an increase in frequency of febrile complications from prostate biopsy. Deaths from post biopsy sepsis were reported by 1% of urologists.

CONCLUSIONS

Our survey shows that most urologists do not follow AUA guidelines. The AUA recommends giving antibiotics 60minutes before starting procedure and continuing for no more than 24hrs. Most urologists start antibiotics the night before procedure and continue them for a few days. Hospitalization for post biopsy sepsis is not uncommon and deaths from prostate biopsy were reported. Febrile complications after prostate biopsy seem to be increasing. There is a need to perform a well-controlled trial to determine the best prophylaxis for prostate biopsy. We believe this data will help us design one for our institution.