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Re: Predictors of Infectious Complications After Targeted Prophylaxis for Prostate Needle Biopsy

      Papagiannopoulos D, Abern M, Wilson N, et alJ Urol 2018;199:155–60Experts’ summary:Papagiannopoulos et al [
      • Papagiannopoulos D.
      • Abern M.
      • Wilson N.
      • et al.
      Predictors of infectious complications after targeted prophylaxis for prostate needle biopsy.
      ] are to be congratulated on their reporting of over 5000 men undergoing transrectal ultrasound-guided (TRUS) prostate biopsy with targeted antimicrobial prophylaxis with preprocedure rectal swab cultures. This method led to an overall infectious complication rate of 1.1%, whilst it was 3.9% for those harbouring a fluoroquinolone-resistant organism (odds ratio 9.98). Their article concluded that one should consider using alternative biopsy approaches to minimise infectious complications in this higher-risk cohort who harbour fluoroquinolone resistance.Experts’ comments:Some areas are worth highlighting. First, exclusion of men from the study due to no follow-up might have incorporated a selection bias, diluting the actual sepsis rates. Second, one might argue that even a sepsis rate of 1.1% for thousands of men (up to 1 million in Europe and another million in the USA) having a diagnostic test is perhaps not acceptable, and all men warrant and deserve an alternative safer approach. With the recent publications of PROMIS and PRECISION showing inferiority of diagnostic performance for TRUS biopsy, how far are we prepared to accommodate such a diagnostic test that confers microbiological harm [
      • Ahmed H.U.
      • El-Shater Bosaily A.
      • Brown L.C.
      • et al.
      Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.
      ,

      Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. In press. https://doi.org/10.1056/NEJMoa1801993.

      ]?
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      References

        • Papagiannopoulos D.
        • Abern M.
        • Wilson N.
        • et al.
        Predictors of infectious complications after targeted prophylaxis for prostate needle biopsy.
        J Urol. 2018; 199: 155-160
        • Ahmed H.U.
        • El-Shater Bosaily A.
        • Brown L.C.
        • et al.
        Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.
        Lancet. 2017; 389: 815-822
      1. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. In press. https://doi.org/10.1056/NEJMoa1801993.

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