René Raaijmakers

Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program.

OBJECTIVES To evaluate the complication rates and possible risk factors of biopsy of the prostate, with the aim of improving patient counseling and the safety of the procedure. Biopsy of the prostate has to be a relatively safe procedure and the participants have to be well informed about the possible complications. METHODS Within the biopsy protocol of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer, we evaluated 5802 transrectal ultrasound-guided systematic sextant biopsies. All participants received prophylactic antibiotic therapy. RESULTS We performed 5802 biopsies. Hematuria lasting longer than 3 days and hematospermia were present after 22.6% and 50.4% of the procedures, respectively. More severe complications were far less frequent. Two hundred participants (3.5%) developed fever after biopsy. Urinary retention was seen 20 times (0.4%), and hospitalization was needed in 27 cases (0.5%). Twenty-five of these men were admitted because of signs of prostatitis and/or urosepsis. Risk factor analyses revealed that an earlier episode of prostatitis was significantly associated with hospital admission and pain after biopsy. Characteristics of prostatic hyperplasia, such as prostate volume, transition zone volume/total prostate volume ratio, and a higher International Prostate Symptom Score, were all predictors of urinary retention. CONCLUSIONS Minor complications are frequently seen but major complications are rare after prostate biopsy. Assessment of the risk factors before biopsy can help to improve the adequacy of counseling, and precautionary measures can be taken to minimize the risk of complications after the procedure. Transrectal ultrasound-guided sextant biopsy remains a safe procedure for the diagnosis of prostate cancer within the general population.

Determining the cause of death in randomized screening trial(s) for prostate cancer

H.J. DE KONING, J. BLOM*, J.W. MERKELBACH†, R. RAAIJMAKERS‡, H. VERHAEGEN¶, P. VAN VLIET**, V. NELEN††, J.W.W. COEBERGH, A. HERMANS¶, S. CIATTO‡‡ and T. MÄKINEN Erasmus MC, Department Public Health, *Saint Franciscus Gasthuis, †Consultant Surgeon, Rotterdam, ‡Erasmus MC, Department of Urology, Rotterdam, the Netherlands, ¶Oncology Center Antwerp, Antwerp, **ACZA – campus St. Elisabeth, Department Urology, Antwerp, ††Prov. Institute voor Hygiene, Antwerp, Belgium, and ‡‡Centro per lo Studio e la Prevenzione Oncologica, Department Diagnostic Medical Imaging, Firenze, Italy

Four-year prostate-specific antigen progression in the non-cancer population of the European Randomized Study of Screening for Prostate Cancer

To determine the rate of conversion of prostate‐specific antigen (PSA) to values of > 4 ng/mL in a normal male population.