title: Indications, Utilization and Complications Following Prostate Biopsy: New York State Analysis.
abstract: Uptake of active surveillance and changes in prostate cancer care may affect the utilization of and complications following prostate needle biopsy. We characterized recent trends and risk factors for prostate needle biopsy complications using a statewide, all-payer cohort.
  
  
  
  We used SPARCS (New York Statewide Planning and Research Cooperative System) to identify prostate needle biopsies performed between 2011 and 2014 via the transrectal and the transperineal approach (9,472 and 421 patients, respectively). We characterized trends in utilization and complications using Poisson regression and the Cochrane-Armitage test. We applied logistic regression to examine predictors of complications within 30 days of prostate needle biopsy.
  
  
  
  Ambulatory use of prostate needle biopsy decreased with time (p <0.01). The most common indication for prostate needle biopsy was elevated prostate specific antigen in 53.2% of patients, followed by active surveillance for cancer in 26.7%, abnormal digital rectal examination in 2.6% and atypia in 1.6%. The prostate needle biopsy associated infection rate increased from 2.6% to 3.5% during the study period (p = 0.02). Among the 777 repeat prostate needle biopsies, the complication rate was comparable to that of initial prostate needle biopsy. Preprocedural rectal swab was done in less than 1% of prostate needle biopsies. On multivariable analysis, patient race, procedure year, diabetes (OR 1.92, 95% CI 1.29-2.86, p <0.01), transrectal approach (OR 3.48, 95% CI 1.27-9.54, p = 0.02) and recent hospitalization (OR 2.03, 95% CI 1.43-2.89, p <0.01) were significantly associated with infection. The median total charge for infectious complications was $4,129 (IQR 711-19,185).
  
  
  
  Across New York State, infectious complications after prostate needle biopsy have increased over time. With higher complications using the transrectal approach and minimal utilization of targeted antibiotic prophylaxis, further efforts should focus on the evaluation and implementation of these strategies to reduce post-prostate needle biopsy complications nationally.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Halpern
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Dinerman
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Hsu
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York. Electronic address: jch9011@med.cornell.edu.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012307:Risk Factors
keywords: biopsy; complications; iatrogenic disease; infection; prostatic neoplasms