NEW YORK (Reuters Health) – A small but significant increase in mortality is seen within 120 days of transrectal ultrasound guided (TRUS) prostate biopsy, according to a report in the August 1st issue of the International Journal of Cancer.

The authors caution, however, that further studies are needed to verify this association and to uncover the mechanisms involved.

The results stem from a population based study of 22,175 patients who underwent prostate biopsy from 1989 to 2000. A control group included 1778 similar men who did not undergo biopsy. Half of the men in the patient group were used to generate a predictive model for 120-day mortality and half were used to validate the predictors.

Overall, 120-mortality in the biopsy group was higher than in the control group: 1.3% vs. 0.3% (p < 0.001), Dr. Pierre I. Karakiewicz, from the University of Montreal, and colleagues report. Age, comorbidities, and number of biopsy procedures also affected mortality. Men younger than 61 years had a mortality rate of 0.2%, compared with 2.5% for men over 75 years. Without comorbid disease, mortality was 0.7% versus 2.2% with multiple comorbidities. First-ever biopsy had a mortality rate of 1.4%, while subsequent biopsies were associated with a rate of 0.8% or less. A model incorporating all of the identified risk factors was 79% accurate in predicting mortality within 120 days of prostate biopsy, the report shows. The findings suggest that the indications for prostate biopsy may need to be reconsidered, the researchers comment. In particular, careful prescreening of older and less healthy men is warranted to determine if the benefits of biopsy outweigh the risks, they note. Research has already shown that these men gain the smallest benefit from diagnosis of early prostate cancer. Reference:
Int J Cancer 2008;123:647-652.