A prostate biopsy obtains tissue samples from the prostate gland to check for cancer. Although generally safe, the procedure carries a small risk of infection, which is the most significant complication. Bacteria introduced from the rectum into the prostate or bloodstream can lead to serious illness. Understanding the signs and timeline for infection is important for patient safety.
The Critical Window for Post-Biopsy Infection
The highest risk for developing an infection occurs immediately after the procedure, as bacteria from the rectal area may have been introduced into the prostate tissue. The onset of a significant infection, such as prostatitis or sepsis, most commonly begins within the first two to seven days following the biopsy.
A serious infection requiring hospitalization occurs in a small percentage of cases, approximately one in every hundred men who undergo a transrectal biopsy. While most infections manifest within the first week, patients should remain aware of the possibility of a delayed onset. Although rare, an infection can sometimes present up to 30 days after the procedure.
Identifying Symptoms of Post-Biopsy Infection
Minor side effects are common and include a small amount of blood in the urine, stool, or semen, which can persist for several days to a few weeks. Mild discomfort or a burning sensation during urination is also often experienced initially and generally resolves on its own.
Signs of a serious infection, such as acute bacterial prostatitis or sepsis, necessitate immediate contact with a physician or a visit to the emergency room. Recognizing these severe symptoms and acting quickly can prevent a manageable infection from progressing to a life-threatening condition.
Serious Symptoms Requiring Immediate Care
A high temperature, typically over 101°F (38.3°C), accompanied by shaking chills or rigors, is a primary indicator of a systemic infection. Severe, persistent pain in the lower abdomen, pelvis, or genital area that is not relieved by over-the-counter medication should also raise concern. Another serious symptom is the inability to pass urine, known as acute urinary retention, which can occur if the prostate swells significantly due to inflammation or infection. Signs of sepsis include a rapid heart rate, fast breathing, confusion, or pale, blotchy skin.
Prevention and Prophylactic Measures
The primary preventative measure before the biopsy is the use of prophylactic antibiotics to reduce bacteria in the rectum and prostate tissue. These are typically prescribed shortly before and sometimes after the procedure. The goal is to ensure sufficient medication concentration is present to eliminate any bacteria introduced by the biopsy needle.
Historically, fluoroquinolone antibiotics were the standard prophylaxis. However, resistance in bacteria, primarily Escherichia coli, is increasing, complicating this strategy. Physicians now often employ an augmented regimen, which may involve a combination of antibiotics or using results from a rectal swab culture to tailor the selection to the patient’s bacterial profile.
Following the procedure, patients minimize infection risk by strictly adhering to all post-biopsy instructions. It is important to complete the entire course of prescribed antibiotics, even if feeling well. Maintaining good hydration helps flush the urinary system, and avoiding strenuous activity for several days reduces the risk of complications.
Treatment Protocols for Confirmed Infection
If symptoms suggest a serious infection, the patient is typically admitted to the hospital for immediate treatment. The first step is the prompt administration of broad-spectrum antibiotics delivered intravenously. This ensures the medication reaches the bloodstream quickly and in high concentration to fight the infection effectively.
Blood and urine cultures are collected immediately to determine the exact type of bacteria causing the infection and its susceptibility to various antibiotics. This allows the medical team to tailor the treatment, a process known as de-escalation. Treatment often involves several days of intravenous antibiotics in the hospital, followed by a course of oral antibiotics completed at home.