To the Editor: Prostate cancer screening remains controversial. There is currently a lack of evidence that treating prostate cancers identified by screening leads to prolonged survival,1 and the main screening test (serum prostate-specific antigen [PSA] concentration) has poor sensitivity and specificity. Patients with an elevated PSA level usually undergo a transrectal ultrasound-guided (TRUS) prostate biopsy for definitive diagnosis. TRUS biopsy is associated with risks that include bleeding, urinary tract infections, prostatitis and bacteraemia. Infective complications can occur even when prophylactic antibiotics are administered.2 Gram-negative bacteraemia is usually associated with a mortality rate of at least 5%.3
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- 1 Academic Unit of Internal Medicine, Australian National University, Canberra Hospital, Canberra, ACT.
- 2 Infectious Diseases Unit and Microbiology Department, Canberra Hospital, Canberra, ACT.
- 1. Ilic D, O’Connor D, Green S, Wilt T. Screening for prostate cancer. Cochrane Database Syst Rev 2006; (3): CD004720.
- 2. Djavan B, Waldert M, Zlotta A, et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001; 166: 856-860.
- 3. Peralta G, Sanchez MB, Garrido JC, et al. Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia. J Antimicrob Chemother 2007; 60: 855-863.
- 4. Medicare Australia. Medicare Benefits Schedule (MBS) item statistics reports. http://www.medicareaustralia.gov.au/statistics/dyn_mbs/forms/mbs_tab4ag.shtml (accessed Oct 2007).
- 5. Frankel S, Smith GD, Donovan J, et al. Screening for prostate cancer. Lancet 2003; 361: 1122-1128.