Complications After Systematic, Random, and Image-guided Prostate Biopsy

Eur Urol. 2017 Mar;71(3):353-365. doi: 10.1016/j.eururo.2016.08.004. Epub 2016 Aug 17.


Context: Prostate biopsy (PB) represents the gold standard method to confirm the presence of cancer. In addition to traditional random or systematic approaches, a magnetic resonance imaging (MRI)-guided technique has been introduced recently.

Objective: To perform a systematic review of complications after transrectal ultrasound (TRUS)-guided, transperineal, and MRI-guided PB.

Evidence acquisition: We performed a systematic literature search of Web of Science, Embase, and Scopus databases up to October 2015, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Complications and mortality following random, systematic, and image-guided PBs were reviewed. Eighty-five references were included.

Evidence synthesis: The most frequent complication after PB was minor and self-limiting bleeding (hematuria and hematospermia), regardless of the biopsy approach. Occurrence of rectal bleeding was comparable for traditional TRUS-guided and image-guided PBs. Almost 25% of patients experienced lower urinary tract symptoms, but only a few had urinary retention, with higher rates after a transperineal approach. Temporary erectile dysfunction was not negligible, with a return to baseline after 1-6 mo. The incidence of infective complications is increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI-targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, regardless of biopsy technique.

Conclusions: Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. The patient's general health status, risk factors, and likelihood of antimicrobial resistance should be carefully appraised before scheduling a PB.

Patient summary: We reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, complications seldom represent a problem for the patient. The most troublesome complications are infections. To minimize this risk, the patient's medical condition should be carefully evaluated before biopsy.

Keywords: Complications; Hospitalization; Infection; MRI-guided biopsy; Mortality; Prostate biopsy.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Biopsy / methods
  • Endosonography
  • Erectile Dysfunction / epidemiology
  • Hematuria / epidemiology
  • Hemospermia / epidemiology
  • Humans
  • Image-Guided Biopsy / methods*
  • Lower Urinary Tract Symptoms / epidemiology
  • Magnetic Resonance Imaging
  • Male
  • Postoperative Complications / epidemiology*
  • Postoperative Hemorrhage / epidemiology
  • Prostate / diagnostic imaging
  • Prostate / pathology*
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / pathology*
  • Recovery of Function
  • Rectal Diseases / epidemiology
  • Surgical Wound Infection / epidemiology
  • Urinary Retention / epidemiology