Recent prostate biopsy

[Jake__0]

Posted by Jake on August 12, 1999 at 13:39:59
I am 48 yrs old, and I recently had a prostate biopsy (due to psa count of 4.39) and after the biopsy I had an infection.  I have been given antiobiotics to take for several weeks.  The results showed no evidence of cancer. I have several questions:
1.  Obviously the biopsy caused the infection, but do we know why certain people get infections and most do not?  Is it something that was done during the procedure or was it something that I could have caused afterwards?  
2.  I have 3 older brothers, and two of them were told by their doctors to not even bother getting the psa checked because it is not an accurate test.  Are their doctors more up to date than mine or vica versa?  
3.  The biopsy was extremely painful!  I was not given an anesthetic, and I don't understand why I had to be conscious during the procedure.  Is this normal?  Why did the brochure tell me there would be mild discomfort and yet I experienced incredible pain?  Did I feel pain because there is something wrong with my prostate?
Any insight you can give me will be greatly appreciated.  My urologist is not such a terrific communicator.

Posted by HFHS M.D.-AK on August 12, 1999 at 15:33:00
Dear Jake,
Detection of early prostate carcinoma on rectal examination has been greatly facilitated by the discovery of PSA.  This test is accurate and sensitive such that prostate cancer can be detected on an average of 6.2 years before rectal exam diagnosis.  What your brothers doctor is saying is that 30% of prostate cancers are discovered in patients with lower than 4.0 ng/ml PSA.  There is no excuse for delaying a prostatic biopsy in an otherwise healthy younger man such as yourself with an abnormal rectal exam or elevated PSA.
Infectious complications of transrectal biopsy include, prostatitis, epididymitis, pyelonephritis, local abscess, osteomilitis, and sepsis.  The risk of infection is less than 5% with the appropriate prophyaxis.  It has been reported that 76% of patients have bacteria in the blood five minutes after biopsy.  This is why prophylactic antibiotics are given.  Oral antibiotics 24hrs before the procedure and 24hrs after has been shown to be the most effective to prevent these infectious complications.  However, even with the appropriate coverage, infections still occur.  We don’t know how or why these infections occur in some patients and not others.
In terms of discomfort.  What you describe is within normal limits.  We do not give our patients any anesthetic nor do we put them asleep at our institution.  Of course we try to relax the patient and be as gentle as possible.  But we like to think that the potential benefit of catching prostate cancer early, outweighs to pain of the procedure.  I agree the procedure is uncomfortable.  I cannot comment on your experience because I was not there.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Prostate Biopsy

[Horheh]

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