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UPJ INSIGHT Association of Frailty and Complications Following Prostate Biopsy
By: Kayvon Kiani, MD, University of Colorado, Aurora; Simon P. Kim, MD, MPH, University of Colorado, Aurora; Rodrigo Rodrigues Pessoa, MD, PhD, Mayo Clinic, Rochester, Minnesota; Boris Gershman, MD, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Christopher Gonzalez, MD, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; Elizabeth Molina, MPH, Population Health Shared Resource (PHSR), University of Colorado Cancer Center, Aurora, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora; Adam Warren, MPH, Population Health Shared Resource (PHSR), University of Colorado Cancer Center, Aurora, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora; Rodrigo Donalisio DaSilva, MD, University of Colorado, Aurora; Brian Chapin, MD, MD Anderson Cancer Center, Houston, Texas; Eric Ballon-Landa, MD, MPH, University of Colorado, Aurora, VA Eastern Colorado Health Care, Aurora | Posted on: 19 Jan 2024
Kiani K, Kim SP, Pessoa RR, et al. Association of frailty and complications following prostate biopsy: results from a population-based, privately insured cohort. Urol Pract. 2024;11(1):117-122.
Study Need and Importance
Prostate biopsy is a potentially risky procedure that is commonly performed in older men, who may be frail. Although guidelines recommend against biopsy in men with limited life expectancy, it is often challenging to counsel patients to omit intervention. Thus, we sought to analyze the rates of complications among frail men receiving prostate biopsy in a large, nationally representative dataset.
What We Found
Frailty was measured within this claims-based database using the claims-based frailty index, a validated measure of frailty. Even in a relatively young cohort, men with any degree of frailty were more likely to experience a complication of prostate biopsy in the clinic, emergency department, or hospital setting (Figure). Frailty was associated with increased complications independent of age and Elixhauser index on multivariable analysis.
Limitations
While the risk of complication was increased, claims data do not differentiate the route of biopsy performed (transrectal vs transperineal), which may be a driver of complications. Additionally, because the number of frail patients overall was low, we were unable to stratify the analysis by the degree of frailty (prefrail, mild-moderate, severe). Finally, the clinical actionability of the claims-based frailty index is limited and not easily translatable to the patient encounter.
Interpretation for Patient Care
Clinicians challenged to evaluate for prostate cancer in an older, frail population may consider these findings as an additional support to omit biopsy in this high-risk group. Further work should be done to allow for reproducible, reliable evaluation of frailty that can be done in the clinic setting.
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