January 18, 2012
Volume 7 - Issue 3      

DynaMed Weekly Update

For the week ending January 13, 2012  

Last week 886 articles were evaluated via DynaMed's Systematic Literature Surveillance and 108 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Adverse Events Appear Common Following Prostate Biopsy for Elevated PSA Level   


A large body of research suggests that prostate specific antigen (PSA) testing to screen for prostate cancer may not reduce all-cause or prostate-cancer specific mortality (BMJ 2010 Sep 14;341:c4543, Cochrane Database Syst Rev 2010 Nov 10;(11):CD004720). The American Cancer Society recommends that asymptomatic men should have the opportunity to make informed decisions before having a PSA screen (CA Cancer J Clin 2010 Mar-Apr;60(2):70). If a screening test shows high PSA levels, a prostate biopsy is indicated to determine if cancer is present. A recent cohort study investigated the rates of adverse events associated with prostate biopsy.


A total of 1,147 men (mean age 62 years, mean PSA level 5.4 ng/mL) had a 10 core transrectal ultrasound-guided biopsy performed with antibiotic prophylaxis. The men completed a questionnaire about pain, infection, and bleeding at time of biopsy and at 7 and 35 days after the biopsy. Pain was reported by 44% within 35 days of the procedure, with 7% reporting it as a moderate to serious problem. Bleeding was also common (urinary bleeding in 66%, rectal bleeding in 37%, blood in semen in 93%). Fever occurred in 18% and shivers in 19%. At 7 days after the biopsy, 19.6% reported that repeat biopsy would be a moderate to major problem. Factors associated with negative attitudes toward repeat biopsy included pain immediately following biopsy (odds ratio [OR] 12.1), pain at 7 days after biopsy (OR 8.2), symptoms related to infection (OR 7.9), and bleeding (OR 4.2) (level 2 [mid-level] evidence) (BMJ 2012 Jan 9;344:d7894). These findings may be of use to patients and their care providers when considering the risks and benefits of prostate cancer screening.


For more information, see the Prostate cancer screening topic in DynaMed.

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: January 18, 2012 
Expiration Date: January 18, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.

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ACCME This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians.  Antidote Education Company designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102071U.

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