Question (10/26/2011):

Title: Prostate biopsy pre test.

I am going to have a prostate biopsy in 2 weeks.

Next week my doc wants me to come in for a swab.

I understand that this involves antibiotic issues.

However, is the pre-biopsy swab the standard of care, or just a study?

Answer:

It is usually performed a transrectal prostate biopsy directed by ultrasound when there is a suspicion that there may be a prostate cancer, either because the exploration of the prostate by digital rectal examination reveals the presence of a nodule or because the antigen determination in blood prostate specific (PSA) is abnormal.

The biopsy is usually performed with the patient lying on one side, with knees drawn up, in contact with the chest.

Normally, the urologist performs a digital rectal examination to assess the size and characteristics of the prostate and if there is any impediment to proceed with the exploration.

Then a special ultrasound transducer is inserted into the rectum, covered with a prophylactic and lubricated material for the process not to be annoying.

The transducer is a cylinder slightly thicker than a finger, emitting ultrasounds that are reflected in the prostate, producing a visible image on a television monitor.

After the ultrasound study of the prostate, it is used a special guide that helps direct the biopsy needle to the prostate area to be studied.

The biopsy needle is connected to a trigger device that introduces the needle at high speed inside and outside the prostate tissue, resulting in a cylinder of tissue that is placed in a container in formaldehyde, with a label reflecting prostatic reference location.

Most patients experience some discomfort during the biopsy, but it is so fast that the discomfort only lasts one second.

The number of prostate samples normally collected is from 6 to 8, although in special cases it can be increased to 12-20.

The procedure can be performed without anesthesia, with local anesthesia, or when necessary to perform many biopsies, with spinal or epidural anesthesia.

Antibiotics are typically given at the end of the procedure to prevent the occurrence of prostate infection.

Some patients notice the presence of blood in the urine for a couple of days after the biopsy, which usually requires no treatment.

The American Urological Association (AUA) Best Practice Policy Statement advises antimicrobial prophylaxis (prevention with antibiotics) in all patients having a transrectal prostate biopsy and recommends fluoroquinolones (namely Cipro and Levaquin) as the antibiotic of choice.

However, currently no uniform protocol addresses the escalating problem of fluoroquinolone resistant organisms that are responsible for the majority of urinary tract infections and, more significantly, for bloodstream infection, after diagnostic transrectal ultrasound guided biopsy of prostate.

If the rectal swab cultures do not show fluoroquinolone resistance, a fluoroquinolone is given 2 hours prior to the prostate biopsy. If resistance is detected, the appropriate antimicrobial based on bacterial sensitivity is selected and administered.

 

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