Safety of transrectal ultrasound-guided needle biopsy of the prostate

Background: Transrectal ultrasound-guided needle core biopsy of the prostate is an important diagnostic procedure in the documentation of prostate cancer. It has replaced the finger-guided blind biopsy since the introduction and wide use of transrectal ultrasonography. However, there has been little discussion about the safety and complications of the procedure. The present study is a retrospective review of the important issues. Materials and Methods: From June 1991 to June 1994, 279 men received transrectal ultrasound-guided biopsy of the prostate to examine the presence of prostate malignancy. From each patient, one to four prostate pieces were obtained for tissue diagnosis. No rectal enema was given before transrectal ultrasound-guided needle biopsy. However, most of the patients were given 200 mg norfloxacin (or equivalent dose of quinolone antiseptics) twice orally on the day of biopsy to prevent bacterial infection. Chart records were reviewed for post-biopsy complications. Results: Twenty-two patients (7.9%) suffered from major complications, including three patients with two complications each. Complications consisted of gross hematuria (13 cases), fever (seven cases), acute urine retention (four cases), and hematospermia (one case). No mortality occurred in our series. Patients with chronic prostatitis, diabetes mellitus and bleeding tendency had higher complication rates. No difference in complication rates was obtained between different age groups of patients. Neither did the number of punctures of the prostate affect complication rates. Conclusion: In conclusion, transrectal ultrasound-guided biopsy is a relatively safe procedure with the low complication rate of 7.9% in our series. All complication episodes were managed successfully. Patients with chronic prostatitis, diabetes mellitus and bleeding tendency should be carefully assessed before biopsy. Whether it is beneficial to use prophylactic antibiotics before biopsy demands further investigation.