1. Department of Urology, New York University, New York, NY, USA;2. Division of Surgery and Interventional Science, University College London, London, UK;3. Academic Urology Unit, University of Sheffield, Sheffield, UK;4. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;5. Department of Urology, University Vita-Salute, Scientific Institute H San Raffaele, Milan, Italy;6. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Abstract:
Context
Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment.
Objective
To perform a systematic review of complications from prostate biopsy.
Evidence acquisition
A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality.
Evidence synthesis
After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare.
Conclusions
Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
