# 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](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list%5Fuids=20843937&holding=caugamlib), [Cochrane Database Syst Rev 2010 Nov 10;(11):CD004720](http://www.ncbi.nlm.nih.gov/pubmed?term=16856057%5buid%5d%20AND%20CD004720%5bpg%5d)). 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](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list%5Fuids=20200110&holding=caugamlib)). 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](http://www.epnet.com/dynamed/levels.php)) ([BMJ 2012 Jan 9;344:d7894](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=22232535)). 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](http://search.ebscohost.com/login.aspx?direct=true&db=dme&AN=113802&site=dynamed-live&scope=site) topic in DynaMed.