title: Psychological impact of prostate biopsy: physical symptoms, anxiety, and depression.
abstract: OBJECTIVE
  To investigate the psychological impact of prostate biopsy, including relationships between physical biopsy-related symptoms and anxiety and depression.
  
  
  METHODS
  A prospective cohort of 1,147 men, nested within the Prostate Testing for Cancer and Treatment trial and recommended to receive prostate biopsy, completed questionnaires assessing physical and psychological harms after biopsy in the Prostate Biopsy Effects study. Psychological impact was measured using the Hospital Anxiety and Depression Scale, and scores were compared according to experiences of biopsy-related symptoms at biopsy, and at 7 and 35 days afterward, and in relation to biopsy results.
  
  
  RESULTS
  A total of 1,144 men (99.7%) returned questionnaires at biopsy, with 1,090 (95.0%) and 1,016 (88.6%) responding at 7 and 35 days postbiopsy. Most men experienced biopsy-related symptoms as no problem or a minor problem, and overall levels of anxiety and depression were low and similar to normative levels. Of men receiving a negative biopsy result (n = 471), anxiety was greater in those experiencing problematic biopsy-related symptoms compared with those experiencing nonproblematic symptoms at 7 days for the following symptoms: pain (P < .001), shivers, (P = .020), hematuria (P < .001), hematochezia (P < .001), and hemoejaculate (P < .001). Anxiety was reduced, although symptoms were not, after 35 days. Overall levels of anxiety were low across all time points except at the 35-day assessment among men who had received a cancer diagnosis.
  
  
  CONCLUSIONS
  Problematic postbiopsy symptoms can lead to increased anxiety, distinct from distress related to diagnosis of prostate cancer. Men and doctors need to consider these additional potential harms of biopsy when deciding whether to initiate prostate-specific antigen testing.
authors.affiliation: Julia Wade, Rhiannon C. Macefield, Kerry N.L. Avery, C. Elizabeth Salter, Jane M. Blazeby, J. Athene Lane, Chris Metcalfe, and Jenny L. Donovan, University of Bristol, Clifton, Bristol; Derek J. Rosario and M. Louise Goodwin, Royal Hallamshire Hospital, University of Sheffield, Sheffield; David E. Neal, University of Cambridge, Addenbrooke's Hospital, Cambridge; and Freddie C. Hamdy, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Wade
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rosario
authors.forename: Rhiannon C
authors.initials: RC
authors.lastname: Macefield
authors.forename: Kerry N L
authors.initials: KN
authors.lastname: Avery
authors.forename: C Elizabeth
authors.initials: CE
authors.lastname: Salter
authors.forename: M Louise
authors.initials: ML
authors.lastname: Goodwin
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.forename: Chris
authors.initials: C
authors.lastname: Metcalfe
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Donovan
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D001706:Biopsy / Q000523:psychology*; D003863:Depression / Q000523:psychology; D006801:Humans; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013997:Time Factors