Complications of Transrectal Ultrasound-Guided Extended 12-Core Prostate Biopsy

Abstract

Background: In Nigeria, Prostate cancer is the most diagnosed cancer in males from middle age. The only definitive way to confirm prostate cancer is through prostate biopsy. Trans-rectal Ultrasound (TRUS) guided core needle biopsy of the prostate has become the procedure of choice for obtaining high quality tissue cores for histopathologic assessment in patients with suspected prostate cancer. Despite being considered generally a safe technique, TRUS-guided prostate biopsy is an invasive process with potential risks. We assessed the complications arising from 12-core prostate biopsy performed under TRUS guidance in this prospective study. Objectives: The aim of this study was to report the common complications and incidence rate after 12-core extended biopsy protocol using TRUS guided needle biopsy amongst patients being evaluated for prostate cancer in Lagos University Teaching Hospital, Lagos. Methodology: This study was a prospective hospital-based study involving patients evaluated for prostate cancer. All study participants, mean age 68.1years received antibiotic prophylaxis five minutes to the procedure and a laxative was administered a day prior to the procedure. Also all patients had thorough clinical evaluation including digital rectal examination (DRE), serum assay for prostate specific antigen (PSA), radiologic imaging of the prostate with Trans-Rectal Ultrasound (TRUS) and TRUS guided Extended 12-core needle biopsy of the prostate (including 6-Sextant and 6-lateral core biopsies). Results: Result of 134 prostate biopsies performed in selected patients were reported. 134 men (aged 37-89years) were enrolled in this study and had Extended 12-Core TRUS guided prostate needle biopsy. 78 men (58.2%) were positive for cancer, 52 men (38.8%) had BPH and 4 men(3%) had prostatitis. Complications occurred in 60.4% (81) of patients but most of these complications were minor bleeding complications. The most common complication of the biopsy was rectal bleeding which occurred in 59.7% of patients, followed by Hematuria/ bleeding per urethra in 23.9% of patients. Urinary tract infection after biopsy was most common in patients with prostatitis (p=0.020). Majority of patients (84.3%) found the procedure tolerable with only mild discomfort and 67.9% felt no pain. Study results were generally consistent with other reports on complication rates. Conclusion: The study showed that the TRUS guided 12-core extended biopsy procedure can be safely performed as it is well tolerated with no significant pain or morbidity and without significant increase in complication rate.