Trends and risk factors for prostate biopsy complications in the pre-PSA and PSA eras, 1980 to 1997

Objectives. To assess the secular trends in postbiopsy complications and to identify the risk factors for complications. Methods. Olmsted County residents who underwent a prostate biopsy between 1980 and 1997 were identified. All community medical records for the study subjects were reviewed to identify prostate biopsy-related complications, including gross hematuria, infection, pain, hematospermia, and acute urinary retention. Results. Of the 2258 prostate biopsies, 377 (17%) were associated with at least one complication. The total complication rate per biopsy remained relatively consistent at about 17% from 1980 to 1986, 1987 to 1992, and 1993 to 1997 (P for trend = 0.8). The age-adjusted complication rate (per 100,000 men) increased from 26 to 60 in 1980 to 1986 and 1993 to 1997, respectively (P <0.001). This paralleled the increase in prostate biopsy use from 138 to 374 per 100,000 men in the same periods. The prevalence (per biopsy) of gross hematuria increased, 7.5% to 12.8% (P = 0.04); postbiopsy infection declined, 4.6% to 1.4% (P = 0.001); and hospitalization for infection declined, 1.2% to 0.2% (P = 0.06) between 1980 to 1986 and 1993 to 1997. A urogenital infection 6 weeks before biopsy was associated with an increased risk of a postbiopsy complication (odds ratio = 1.7, 95% confidence interval = 1.0 to 2.8) and an increased risk of a postbiopsy infection (odds ratio = 5.5, 95% confidence interval = 2.2 to 13.8). Conclusions. Although the complications per biopsy have stayed constant, the prevalence of postbiopsy complications in the community has increased tremendously because of the increased use of prostate biopsies. Specific strategies may be needed to reduce the incidence of postbiopsy infection in men with a recent urogenital infection before biopsy.