Transrectal Ultrasound Guided Biopsy Case Study

Transrectal Ultrasound Guided prostate biopsy is the most common method to determine the presence of prostate cancer. Previous studies have shown of an increasing number of men requiring hospitalization as a result of significant infectious complications following prostate biopsy. However, “those were either small studies, or they were derived from a controlled trial designed to examine different end point (Nam et al., 2012, p.13).” They left researchers questioning if it can be employed to a larger population. “Increasing Hospital Admission Rates for Urological Complications After Transrectal Ultrasound Guided Prostate Biopsy” by Nam et al. is one study that aims to answer that. This study's purpose was to examine a large population based

Here are their findings: One of 437 physicians performed each biopsy. Out of the 75,190 men, 33,508 (44.3%) men who underwent TRUS biopsy were diagnosed with prostate cancer. The rest, 41,682 men did not have prostate cancer. The overall hospital admission rate for urological complications within 30 days of the procedure was 1,057/751,90, about 1.4%. For the men who were diagnosed with cancer, the hospital admission rate for urological complications within 30 days of the procedure was 276/33,508, about 0.8%. The 30-day hospital admission rate increased from 0.4% in 1996 to 0.9% in 2005. For the men who did not have cancer the hospital admission rate for urological complications within 30 days of the procedure was 781/41482, about 1.9%. The 30-day hospital admission rate increased from 1.0% in 1996 to 4.1% in 2005. The majority of the hospital admission, (72%), were related in some way to an infection. The overall 30-day mortality rate was 0.09% or 8.5 men died for every 10,000 men who had a biopsy, but this did not change significantly from 1996 to 2005. The researchers conclude that, “ the hospital admission rates for complications following TRUS guided prostate biopsy have increased dramatically during the last 10 years, primarily due to an increasing rate of infection related complications (Nam et al,

First of all, Canada is a government run health care system. The government sets regulations on health care and health preventions. On that noted, the government decides on who and who does not get the biopsies. Biopsies are might have been done on the patients with a “PSA greater than 10 or a defined palpable nodule on rectal exam (CTFPHC, 2014)”. Patients might have been advanced in their disease already. This might be one explanation to the higher rate for positive biopsies. But it doesn’t account for the high hospitalization rates. Some explanations for this would be that the patients were not covered by antibiotics pre and post biopsy, or they were older with comorbidities (Nam et al, 2012). Secondly, “the researchers were not able to perform a medical chart audit, making it difficult to determine the exact cause to why the patients who had been diagnosed with cancer were admitted to the hospital within 30 days the biopsy” (Nam et al, 2012). Some patient looks like they have been admitted for prostate cancer related reasons, but that could also include the patients who actually had complications from the biopsy. What I’m trying to say is that, the doctors could have been “coded” their patients as needing treatment for prostate cancer when they were actually being treated for a complication from TRUS procedure. Lastly, the patients who were treated and discharged home on an outpatient basis,