Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature

Abstract

Purpose: Transrectal ultrasound guided needle biopsy of the prostate is routinely performed to diagnose and stage prostate cancer. We prospectively evaluated the true incidence of complications and identified risk factors of needle biopsy.

Materials and methods: We prospectively studied 128 patients who underwent transrectal ultrasound guided needle biopsy. A pre-biopsy questionnaire provided demographic information. Immediate complications were recorded by the surgical team at the procedure. Information on delayed complications was obtained by telephone interview. Univariate and multivariate analyses were performed.

Results: There was 1 major and 135 minor complications in 77 patients with at least 1 complication in 63.6%. Most patients tolerated the procedure with minimal discomfort regardless of the number and location of biopsies but younger patients had significantly more discomfort than older men (R = -0.26, p = 0.005). The most common complication was persistent hematuria in 47.1% of cases. None of the hemorrhagic complications was related to previous aspirin or nonsteroidal anti-inflammatory drug use, or the total number of biopsies performed. Infectious complications were rare with only a 1.7% incidence of fever. This rate was associated with the choice of antibiotic combination used (R = 0.25, p = 0.006).

Conclusions: Transrectal ultrasound guided needle biopsy is safe for diagnosing prostate cancer with few major but frequent minor complications. Patients are likely to have persistent hematuria for up to 3 to 7 days after the procedure. Recent use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication for this procedure. Additional analgesics are not required in patients who undergo anterior or multiple biopsies but they may be useful in younger patients.