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

We reviewed prostate biopsy-associated bacteraemia in Australian Capital Territory residents using data collected over the 5-year period from 2002 to 2006. All patients in ACT public hospitals who have positive blood culture results are followed as part of a bloodstream infection surveillance program. Although all prostate biopsies are performed in the private sector, nearly all patients who develop major complications are cared for in public hospitals. The number of biopsies performed on ACT residents during the study period was obtained from Medicare Benefits Schedule statistics (item numbers 37215, 37218 and 37219).4

Over the 5-year period, we identified 19 episodes of bacteraemia following 1843 prostate biopsies, representing a 1.0% risk of bacteraemia (95% CI, 0.6%–1.6%) (Box). No patients died, but five required admission to the intensive care unit.

A 1% bacteraemia rate associated with prostate biopsies would be an underestimate of the true rate, for a number of reasons: some patients were also admitted with severe sepsis syndromes but with negative blood cultures; some patients may have been treated in another state; and some patients may have presented to private hospitals, specialists or general practitioners and been treated empirically without blood cultures being collected. Three additional cases of bacteraemia following TRUS biopsies were excluded from our rate calculations because they involved New South Wales residents.

It has been estimated that, if a million men over 50 years of age were screened, about 110 000 would have raised PSA levels.5 Of these, about 90 000 would undergo a biopsy and 20 000 would be diagnosed with prostate cancer. Our data show that TRUS biopsies carry a risk of serious infective complications and, notably, about 75% of these complications would occur in men without prostate cancer.

We believe that data on the likely complication rates resulting from PSA testing and TRUS biopsies must be factored into considerations of the benefits versus risks and the cost-effectiveness of any prostate cancer screening program.