Complications Following Prostate Biopsy: A Single Centre Five Year Review

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Background: Though prostate biopsy is generally a safe procedure, it can be associated with complications. It is important to document the complication rates and identify potential risk factors for these complications. The aim of this study was therefore to investigate the complication rates following prostate biopsy at the Lagos State University Teaching Hospital Ikeja Lagos Nigeria over a 5 year period from January 2012 to December 2016. Patients and Methods: This was a retrospective study in which the clinical records of all the patients who had prostate biopsy at the Lagos State University Teaching Hospital Ikeja, Lagos Nigeria over a 5 year period between January 2012 and December 2016 were retrieved and analyzed. Results: The clinical records of a total of 258 patients were available for review. The mean age was 68.2years (range 45 to 81years). The mean and median PSA values were 560ng/ml and 57ng/ml respectively (range 2.05 to 15,400ng/ml). The prostate biopsy was transrectal and digitally guided in all cases. All the patients had empirical intravenous prophylactic antibiotics with intravenous ciprofloxacin 500mg stat and were discharged on oral ciprofloxacin 500mg bd and oral metronidazole 400mg tds for one week. All the patients had a caudal block. One hundred and seventeen (45.3%) had a comorbidity. The mean prostate size was 109gms (range 16 – 146gms). The size of the trucut needle used was size 16 in 121 patients (46.9%) and size 18 in 125 patients (48.4%). The mean number of biopsy cores taken was 10 (range 4 to 15). The histological diagnosis was carcinoma of the prostate in 154 patients (59.7%) and benign prostatic hyperplasia in 100 patients (38.8%). Twenty four patients (9.3%) had complications. The complications were sepsis (3.1%), rectal bleeding (2.3%), haematuria (2.3%) and acute urinary retention (1.6%). Thirteen patients needed hospitalization (5%). There was no mortality. The incidence of sepsis was statistically significantly higher with increasing the number of cores taken (p=0.000), but there was no significant difference in the incidence of sepsis with the size of the trucut needle used (p= 0.299) or the presence of morbidity (p = 0.503). Conclusion: Though the complication rates following prostate biopsy remain low, increasing number of prostate cores taken is a risk factor for adverse events. We therefore recommend reducing the number of prostate cores taken in patients with advanced prostate cancer with high tumour volume in order to further reduce the risk of prostate biopsy complications in our environment.