Prostat biyopsisi yaşlılarda güvenli mi?

Öz

Amaç : Prostat kanseri tanısında yaygın olarak kullanılan transrektal ultrason (TRUS) eşliğinde prostat iğne biyopsisinin yaşlı hastalarda ne kadar güvenli olduğunu ve görülen komplikasyonların genç hastalardan farkını ortaya koymayı amaçladık. Materyal-metod : 2017-2020 arasında prostat biyopsisi yapılan 515 hasta çalışmaya dahil edildi. Tüm hastaların demografik verileri, ek hastalıkları, laboratuar bulguları, prostat hacimleri, prostat biyopsisi patoloji sonuçları, biyopsi sonrası gelişen komplikasyonlar retrospektif olarak incelendi. Hastalar 65 yaş altı olanlar grup 1 ve 65 yaş üstü olanlar grup 2 olarak 2 gruba ayrıldı. Her iki grupta prostat biyopsisi sonrası görülen komplikasyonlar karşılaştırıldı. Bulgular : Grup 1’de 244, grup 2’de ise 271 hasta vardı. Grup 1 yaş ortalaması 59,50±3,98, grup 2 yaş ortalaması 71,45±4,57 idi. Grup 1’de 5 hastada biyopsi sonrası ateş (%2), 44 hastada hematüri (%18), 79 hastada hematospermi (%32,4), 7 hastada ise rektal kanama (%2,9) izlendi. Grup 2’de ise 15 hastada biyopsi sonrası ateş (%5,5), 69 hastada hematüri (%25,5), 21 hastada hematospermi (%7,7), 11 hastada rektal kanama (%4,1) görüldü. Ancak bu komplikasyonlar dışında grup 1’de 2 hastada (%0,2), grup 2’de 6 hastada (%2,2) ciddi sepsis bulguları izlendi ve hastalar hospitalize edilerek tedavi edildi. Prostat biyopsisi sonrası komplikasyon görülmesini etkileyen risk faktörlerini incelemek için yapılan logistik regresyon analizinde yaş , PSA ve PSA dansitesi yükseldikçe komplikasyon görülme riskinin anlamlı olarak arttığını tespit ettik. Sonuç : Sonuç olarak çalışmamızda yaşlı hastalarda komplikasyon görülme riskinin daha yüksek olduğunu ve görülen komplikasyonların daha ciddi olabileceğini ortaya koyduk. Bu nedenle yaşlı hastalarda prostat biyopsisi öncesi ve sonrası komplikasyon gelişimini önlemek için daha dikkatli yaklaşmak gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• Yaşlı
• iğne biyopsisi
• prostat

Is prostate biopsy safe in the elderly?

Öz

Aim : It was aimed to reveal how safe the transrectal ultrasound guided prostate needle biopsy, which is commonly used in the diagnosis of prostate cancer, was in elderly patients, and the difference of complications from young patients. Material-method: 515 patients, who underwent prostate biopsy between 2017-2020, were included in the study. All patients' demographic data, comorbidities, laboratory findings, prostate volumes, prostate biopsy pathology results, and post-biopsy complications were retrospectively analyzed. The patients were divided in 2 groups: group-1 consisting of patients under the age of 65 and group-2 with above the age of 65. Results: There were 244 patients in group-1 and 271 in group-2. The mean age of group-1 was 59.50±3.98, group-2 was 71.45±4.57. In group-1, post-biopsy fever was observed in 5 patients (2%), hematuria in 44 (18%), hematospermia in 79 (32.4%), and rectal bleeding in 7 (2.9%). In group-2, post-biopsy fever was observed in 15 patients (5.5%), hematuria in 69 (25.5%), hematospermia in 21 (7.7%), and rectal bleeding in 11 (4.1%). Severe sepsis findings were observed in 2 patients (0.2%) in group-1 and 6 (2.2%) in group-2. In the logistic-regression-analysis it was determined that the risk of complication increased significantly as the age, PSA and PSA density increased. Conclusion: In our study it was revealed that the risk of complications was higher in elderly and that the complications observed may be more serious. Therefore, we consider that a more careful approach should be taken in elderly patients to prevent the complications before and after prostate biopsy.

Anahtar Kelimeler

• Aged
• needle biopsy
• prostate

Kaynakça

1. 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015;136:E359.
2. 2. Mottet N, van den Bergh R, Briers E, Cornford P, Santis MD, Fanti S, et al. EAU Guidelines on Prostate Cancer. Eur Urol 2019;76:871.
3. 3. Wammack R, Djavan B, Mesut R, Susani M, Marberger M. Morbidity of transrectal ultrasoundguided prostate needle biopsy in patients receiving immunosuppression . Urology 2001;58:1004–7.
4. 4. Wenzel M, Theissen L, Preisser F, Lauer B, Wittler C, Humke C, Bodelle B, Ilievski V, Kempf VAJ, Kluth LA, Chun FKH, Mandel P and Becker A. Complication Rates After TRUS Guided Transrectal Systematic and MRI-Targeted Prostate Biopsies in a High-Risk Region for Antibiotic Resistances. Front. Surg. 2020;7:7.
5. 5. Loeb, S., Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64:876–92.
6. 6. Bruyère F, Malavaud S, Bertrand P, Decock A, Cariou G, Doublet JD, et al. Prosbiotate: a multicenter, prospective analysis of infectious complications after prostatebiopsy. J Urol. 2015;193:145–50.
7. 7. WHO (1972) Psychogeriatric, report of a WHO Scientific Group, Technical Reports Series 507, Geneva. Cited in Davise AM. Epidemiology 185; 14(1):9-21.
8. 8. Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K et al. The impact of surgical site infection on older operative patients. Am Geriatr Soc. 2009; 57(1):46-54.

9. 9. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987; 40:373.
10. 10. Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S, Weidner W, Loeb S. Complications After Systematic, Random, and Image-guided Prostate Biopsy. Eur Urol 2017 Mar;71(3):353-365.
11. 11. Pinsky P, Parnes H, Andriole G. Mortality and Complications Following Prostate Biopsy in the PLCO Cancer Screening Trial. BJU Int. 2014 Feb; 113(2): 254–259.
12. 12. Dell'Atti L. Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy. Int Braz J Urol. 2017 Nov-Dec; 43(6): 1136–1143.
13. 13. Abdelkhalek M, Abdelshafy M, Elhelaly H, and Kamal M. Hemosepermia after transrectal ultrasound-guided prostatic biopsy: A prospective study. Urol Ann. 2013 Jan-Mar; 5(1): 30–33.13.
14. 14. Brewster D.H, Fischbacher C.M, Nolan J, Nowell S, Redpath D, Nabi G. Risk of hospitalization and death following prostate biopsy in Scotland. Public Health. 2017 Jan; 142: 102–110.
15. 15. Toner L, Bolton D, Lawrentschuk N. Prevention of sepsis prior to prostate biopsy. ICUrology 2016;57:94-99.
16. 16. Anderson E, Leahy O, Cheng A, Grummet J. Risk factors for infection following prostate biopsy - a case control study. BMC Infect Dis. 2015; 15: 580.
17. 17. Jones T, Radtke J.P, Hadaschik B, Marks L. Optimizing Safety and Accuracy of Prostate Biopsy. Curr Opin Urol. 2016 Sep; 26(5): 472–480.
18. 18. Grummet JP, Weerakoon M, Huang S, et al. Sepsis and “superbugs”: Should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int. 2014; 114(3):384–8.
19. 19. Loeb S, Carter H, Berndt S, Ricker W, Schaeffer E. Is Repeat Prostate Biopsy Associated with a Greater Risk of Hospitalization? Data from SEER-Medicare. J Urol. 2013 Mar; 189(3): 867–870.