title: Mortality at 120 days after prostatic biopsy: a population-based study of 22,175 men.
abstract: Trans-rectal ultrasound guided biopsy of the prostate represents the diagnostic standard for prostate cancer, but its mortality rate has never been examined. We performed a population-based study of 120-day mortality after prostate biopsy in 22,175 patients, who underwent prostate biopsy between 1989 and 2000. The control group consisted of 1,778 men aged 65-85 years (median 69.5), who did not undergo a biopsy. Univariable and multivariable logistic regression analyses were performed in 11,087 of 22,175 (50%) men subjected to prostate biopsy, to identify predictors of 120-day mortality. Variables were age at biopsy, baseline Charlson comorbidity index and cumulative number of biopsy procedures. We externally validated the model's predictors in the remaining 50% of men. Overall 120-day mortality after biopsy was 1.3% versus 0.3% (p < 0.001) in the control group. Of men aged < or = 60 years, 0.2% died within 120 days versus 2.5% aged 76-80. Zero Charlson comorbidity score yielded 0.7% mortality versus 2.2%, if 3-4. First ever biopsy procedures carried a higher mortality risk than subsequent procedures (1.4 vs. 0.8 vs. 0.6%). In the multivariable model, first ever biopsy, increasing age and comorbidity predicted higher mortality. Overall, the model's variables were 79% accurate in predicting the probability of 120-day mortality after biopsy. In conclusion, our data suggest that prostate biopsy might predispose to higher mortality rate. The certainty of this association remains to be proven.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Hugues
authors.initials: H
authors.lastname: Widmer
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: François
authors.initials: F
authors.lastname: Péloquin
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001706:Biopsy; D015897:Comorbidity; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D016017:Odds Ratio; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors