What’s the downside to a biopsy?

Even if my father takes antibiotics beforehand, could he develop a serious infection when he has a prostate biopsy? Are there other possible complications we should be on the lookout for?

Internist Harvey B. Simon, M.D., editor of the monthly newsletter Harvard Men’s Health Watch responds:

It’s not likely that your father will develop an infection following his prostate biopsy. Most doctors recommend a cleansing enema beforehand and prescribe antibiotics — usually either ciprofloxacin (Cipro) or levofloxacin (Levaquin) — to minimize the risk. These drugs belong to a class of medications called fluoroquinolones. Drugs with tongue-twisting names like gemifloxacin (Factive), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin) fall into this class, too.

Unfortunately, about 2.5% to 3% of men who take fluoroquinolones still develop serious urinary tract infections or bacterial prostatitis within a week of their biopsies. This can happen if the infection-causing bacteria are resistant to the antibiotic that was prescribed. If your father develops a fever, chills, muscle aches, an urgent need to urinate, or frequent or burning urination, be sure he gets medical attention promptly. He may need to receive another antibiotic to halt the infection, and delaying treatment can have serious consequences.

Although fluoroquinolones are effective in treating a variety of bacterial infections, they can raise the risk of tendinitis and tears in the Achilles’ tendon at the back of the ankle and, less often, in other tendons. (Tendons connect muscles to joints.) According to the FDA, the chance of having tendon problems increases in people who are over age 60, are taking steroids, or are organ transplant recipients. Other possible side effects from these popular and effective drugs include allergic reactions, headaches, nausea, and diarrhea.

Admittedly, these complications sound worrying, but keep in mind that most men never experience them. If an infection does develop, with treatment most men feel back to normal within a few days; without it, the reverse is true.

Originally published June 2009; last reviewed February 17, 2011.