title: Pain and morbidity of an extensive prostate 10-biopsy protocol: a prospective study in 289 patients.
abstract: OBJECTIVE
  Some studies imply that increasing the number of prostate biopsy cores may improve the cancer detection rate. We performed a prospective study to evaluate pain and morbidity after an extensive transrectal ultrasound guided 10-core biopsy protocol.
  
  
  METHODS
  A total of 289 consecutive men with abnormal digital rectal examination findings and/or increased prostate specific antigen underwent extensive prostate biopsy involving 6 sextant and 4 peripheral biopsies. Each received an information leaflet a few days before the procedure. A single dose of fluoroquinolone and a rectal enema were administered before biopsy. In no case was the procedure performed using anesthesia. Immediately after biopsy patients were asked to complete a self-administered nonvalidated questionnaire evaluating the degree of pain and/or discomfort using a visual analog scale. In another questionnaire they listed the side effects noticed during month 1 after biopsy.
  
  
  RESULTS
  Although 48% of the 275 men who completed the initial questionnaire reported anxiety before the procedure, 78.8% of them were completely reassured by the information brochure. Of the 275 patients 47.6% described the procedure as painful, including only slightly painful (analog visual scale 3 or less) in 67.9%, while 33.8% described it as uncomfortable but not painful and 18.6% thought that it was neither painful nor uncomfortable. Of the 115 patients who engaged in sexual intercourse during month 1 after the procedure 78.3% noticed hematospermia an average of 10.9 days in duration. Of the 164 men who completed questionnaire 2, 74.4% noticed hematuria an average of 2.7 days in duration, 3.7% noticed pyrexia and 1.2% noticed acute prostatitis. In the 59 patients (36%) who reported delayed perineal pain it was slight in 64.4%, moderate in 30.5% and severe in 5.1%. No patient required hospitalization.
  
  
  CONCLUSIONS
  Although minor complications are common, the extensive 10-core prostate biopsy protocol is associated with few major complications. The occurrence and intensity of pain and discomfort are in the range reported after the standard 6-core biopsy protocol.
authors.affiliation: Department of Urology, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Peyromaure
authors.forename: Vincent
authors.initials: V
authors.lastname: Ravery
authors.forename: Aurel
authors.initials: A
authors.lastname: Messas
authors.forename: Marianne
authors.initials: M
authors.lastname: Toublanc
authors.forename: Lilianne
authors.initials: L
authors.lastname: Boccon-Gibod
authors.forename: Laurent
authors.initials: L
authors.lastname: Boccon-Gibod
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology; D011472:Prostatitis / Q000209:etiology; D011795:Surveys and Questionnaires