Morbidity and psychological impact of prostate biopsy: the future calls for a change

TRUS-Bx. About 25% of men perceived this as a concern, while hematuria and rectal bleeding are usually perceived as minor discomfort and of little consequence by appropriately counseled men. 8 Moreover, hemoejaculate declines over time from 84% in week 1 to 32% after 1 month and is resolved after a mean of eight ejaculations. 9 Due to antimicrobial-resistance, particularly fluoroquinolones, the risk of infectious complications is increasing over time. This represents the most dangerous complication after TRUS-Bx, ranging from asymptomatic bacteriuria, urinary tract infections and epididymitis to more severe ones as sepsis and meningitis. 10 The frequency of infections requiring hospitalization varies between 0.6% and 6.3%. In the Global Prevalence Study of Infections in Urology, 3.1% required hospitalization after biopsy due to febrile-urinary tract infection. 10 Many patients experience a worsening of lower urinary tract symptoms after TRUS-Bx. Urinary retention is usually transient ranging from 0.2% to 1.7%. 6 TRUS-Bx is associated with significant pain and discomfort in a proportion of men. Most studies evaluated pain using the visual analog scale (0 = none to 10 = worst pain), and in a recent study mean score resulted 1.4 (range 0–5) and 18% of patients would not accept a repeat biopsy. 13 Predictors of pain include young age, anxiety level, anorectal compliance, prostate volume and number of biopsy cores; while pain seems not affected by using 16-versus 18-gauge needles. PSYCHOLOGICAL IMPACT OF PROSTATE BIOPSY Some studies have explored the psychological impact, including anxiety and depression, of TRUS-Bx. Zisman and coworkers in a prospective study on 211 men, found a C urrently transrectal ultrasound‑guided prostate biopsy (TRUS‑Bx) is one of the most common urological procedures, with more than 1 million performed per year in Europe and the United States. Standard TRUS‑Bx is likely to systematically miss significant tumors, particularly in the anterior and apical parts of the gland. 3 A crucial aim of urologists in the next decade is to increase the accuracy of the procedure and avoid the use of inappropriate biopsies. MORBIDITY OF PROSTATIC BIOPSY Transperineal and transrectal TRUS-Bx are associated with a significant morbidity with a not negligible risk of hospitalization. Visible hematuria following TRUS-Bx is reported in a significant number of patients ranging between 10% and 84%, according to different definitions.