The Association of Previous Prostate Biopsy Related Complications and the Type of Complication with Patient Compliance with Rebiopsy Scheme

Introduction: Prostate biopsy complications have important consequences that may affect patient compliance with re-biopsy schemes; however, this has not been studied in earnest. Thus, we evaluated whether previous prostate biopsy-related complications and the type of complication were associated with repeat prostate biopsy compliance in a clinical trial with study-mandated systematic biopsies. Materials and Methods: Retrospective analysis of 4,939 men ages 50-75 who underwent a 2-year prostate biopsy and were recommended to undergo the 4-year prostate re-biopsy in the Reduction by Dutasteride of prostate cancer Events (REDUCE) study. The analyzed biopsy complications were: hematuria, urinary tract infection (UTI), acute urinary retention (AUR) and hematospermia. Results: A total of 260 (5.3%) men had a 2-year prostate biopsy-related complication, including 180 (3.6%) hematuria, 36 (0.7%) UTI, 26 (0.5%) AUR, and 102 (2.1%) hematospermia. A total of 474 (9.6%) men were noncompliant with the 4-year re-biopsy. In univariable analysis, any previous complication (OR=1.56, 95%CI=1.08-2.24, P=0.018), UTI (OR=2.72, 95%CI=1.23-6.00, P=0.013), AUR (OR=4.24, 95%CI=1.83-9.81, P=0.016) and hematospermia (OR=1.78, CI=1.03-3.06, P=0.037) were associated with re-biopsy noncompliance. Hematuria was not associated with re-biopsy noncompliance (OR=1.19, CI=0.74-1.91, P=0.483). Results were unchanged in multivariable analysis (any complication: OR=1.65, 95%CI=1.08-2.26, P=0.018; UTI: OR=2.62, 95%CI=1.07-3.21, P=0.029; AUR: OR=4.51, 95%CI=1.93-10.54, P=0.001; hematospermia: OR=1.85, 95%CI=1.07-3.21, P=0.029; hematuria: OR=1.19, 95%CI=0.74-1.93, P=0.472). Conclusion: In men undergoing repeat prostate biopsy, a previous biopsy-related complication and the type of complication were associated with lower compliance with re-biopsy schemes. Patients experiencing biopsy-related complications are ideal candidates to receive interventions regarding the importance of prostate re-biopsy to prevent noncompliance

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

PURPOSE: To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. MATERIALS AND METHODS: From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. RESULTS: There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 ± 1.6 vs. 13.1 ± 1.2 cores, p = 0.09). No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5% vs. 60.6%, p = 0.46), rectal bleeding (33.6% vs. 25.9%, p = 0.09) or hemospermia (90.1% vs. 86.9%, p = 0.45). The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 ± 2.7 vs. 2.4 ± 2.6, p = < 0.001 and 3.3 ± 1.3 vs. 1.9 ± 0.7, p < 0.001). Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 ± 5.8 years) with a lower body mass index (< 25 kg/m2) receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047) for developing hematuria and rectal bleeding after the procedure. CONCLUSIONS: The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure