VARIABILITY IN PATIENT PREPARATION FOR PROSTATE
BIOPSY AMONG AMERICAN UROLOGISTS
KEVIN C. SHANDERA, GREGORY P. THIBAULT,
AND
GEORGE E. DESHON, J
R
ABSTRACT
Objectives. To assess the variability in patient preparation for prostate biopsy (PBX) among practicing
American urologists.
Methods. A survey was sent to 900 practicing American urologists randomly selected by the American
Urological Association computer files. The survey asked about their pre-PBX protocol.
Results. Approximately 63% (568 of 900) of the surveys were returned and showed considerable differ-
ences in pre-PBX protocol among those urologists. The pre-PBX regimen included prophylactic antibiotics in
98.6% and a cleansing rectal enema in 81%. Eleven different antibiotics were used, with 20 different doses
and 23 different timing-duration regimens.
Conclusions. The pre-PBX preparation is not standardized among American urologists.
UROLOGY
52:
644–646, 1998.
A
denocarcinoma of the prostate is the most
common cancer of men living in the United
States. The American Cancer Society estimated
that 184,500 new cases of prostate cancer will be
diagnosed in the United States in 1998.
1
The diag-
nosis of prostate carcinoma is made by transrectal
biopsy of the prostate, one of the most common
procedures performed by urologists. Sextant biop-
sies are the accepted standard of care for diagnos-
ing adenocarcinoma of the prostate. However,
there is no accepted standard of care in the patient
preparation before prostate biopsy (PBX). The re-
ported incidence rate of bacteremia after transrec-
tal PBX without antibiotic prophylaxis ranges from
16% to 100%.
2–5
Most urologists provide prophy-
lactic antibiotics with or without a cleansing rectal
enema to minimize this risk. Ideally, the prebiopsy
preparation would be simple, economical, and ef-
fective at preventing infectious complications, as
well as uniform among urologists. The objective of
this study is to assess the variability in the prebi-
opsy preparation among American urologists.
MATERIAL AND METHODS
A computer-generated list of 900 randomly selected urolo-
gists practicing in the United States was obtained from the
American Urological Association (AUA) in July 1996. The list
included urologists from all 50 states, the District of Colum-
bia, and Puerto Rico. A survey was sent to these urologists,
asking about their pre-prostate biopsy patient preparation.
More specifically, they were asked whether prophylactic anti-
biotics were used, the name(s), route(s) of administration,
dosage(s), timing of antibiotics given before and after PBX,
and whether a bowel cleansing enema was used. Additional
questions included in the survey were the number of biopsy
specimens obtained, the route of biopsy, and the ultrasound
machine used.
RESULTS
The survey was completed and returned by 568
of the 900 (63.1%) urologists. Of these respon-
dents, 98.6% prescribed some form of antibiotic
prophylaxis before PBX (Table I). Oral antibiotics
only were used by 93.3%, intramuscular antibiot-
ics only by 3.5%, and a combination of oral and
intramuscular antibiotics by 3.3%. A total of 11
different antibiotics were reported with 20 differ-
ent dosages; however, oral quinolones were chosen
by 91.6% of the respondents either alone or in
combination with another antibiotic. Twenty-
three percent of the respondents used two drugs
for prophylaxis. The duration of prophylactic
treatment ranged from one dose to 17 days (3 days
before PBX and 14 days after), with 23 different
timing-duration regimens reported (Fig. 1). Dos-
The opinions expressed herein are those of the authors and do not
necessarily reflect those of the Department of the Army or the
Department of Defense.
From the Tripler Regional Medical Center, Honolulu, Hawaii
Reprint requests: Kevin C. Shandera, M.D., Hawes Urology
Clinic, P.A., 1333 Romany Road, Charlotte, NC 28204
Submitted: March 9, 1998, accepted (with revisions): April 21,
1998
ADULT UROLOGY
644 PII S0090-4295(98)00313-6