Adverse Events Appear Common Following Prostate Biopsy for Elevated PSA Level

DynaMed Weekly Update - Volume 7, Issue 3

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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.