Immediately after a first prostate biopsy only one in ten men had concerns about undergoing a repeat biopsy, this proportion had increased to one in five at seven days, according to a study in the BMJ.

Between February 2006 and May 2008 1,147 men, mean age 62.1 and mean PSA 5.4 ng/ml, undergoing 10-core prostate biopsy were recruited into the ProBE (Prostate Biopsy Effects) study. This large prospective cohort study is part of the larger ProtecT (Prostate Testing for Cancer and Treatment) study, a multicentre randomised controlled trial started several years ago to evaluate the effectiveness and acceptability of treatments for men with localised prostate cancer.

The main adverse effects seen were pain (in 43.6% of men), fever (17.5%), haematuria (65.8%), haematochezia (36.8%) and haematospermia (92.6%) during the 35 days after biopsy. These symptoms were graded by the men as mild, moderate or severe – only 7.3% of men rated pain as moderate or severe, 5.5% for fever, 6.2% for haematuria, 2.5% for haematochezia and 26.6% for haematospermia.

This is very useful information for GPs counselling men prior to referral for prostate biopsy, particularly to reassure men that the vast majority will experience either no pain or mild pain.

Experience of biopsying men suggests that the more relaxed the patient feels about having a biopsy the less pain they experience, so a positive attitude from the referring GP can be of great help to the patient.

Men were questioned after the biopsy about how they would feel about a repeat biopsy if clinically indicated. Immediately after biopsy, 10.9% of men reported that this would be a major or moderate problem. This figure had increased to 19.6% by seven days after biopsy – this was clearly linked to an unfavourable experience of biopsy, particularly pain, infection and bleeding.

As a result of adverse effects of biopsy 10.4% of men consulted with a healthcare professional, usually their GP.

So an understanding of prostate biopsy, the normality of haematuria and other bleeding post-biopsy and how to deal with post-biopsy fever is important for primary care physicians.

The study is well designed and shows that for the majority of men, the procedure is well tolerated and safe. For a minority, however, pain during the procedure, or post-biopsy complications such as infection and bleeding can be significant and full counselling regarding this is vital, particularly in the context of informed decision making around PSA screening and biopsying men with borderline PSAs.

Dr Jonathan Rees