Urologic Oncology: Seminars and Original Investigations ] (2017) ∎∎∎–∎∎∎ Original article Physical after-effects in men undergoing prostate biopsy in routine clinical practice: Results from the PiCTure study Eileen Morgan, Ph.D. a, * , Frances J. Drummond, Ph.D. b , Catherine Coyle, M.D. c , Linda Sharp, Ph.D. d,1 , Anna T. Gavin, M.D. a,1 a Northern Ireland Cancer Registry, Centre for Public Health, Belfast, Northern Ireland b Department of Epidemiology and Public Health, University College Cork, Cork, Republic of Ireland c Public Health Agency for Northern Ireland, Belfast, Northern Ireland d Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom Received 22 December 2016; received in revised form 31 May 2017; accepted 1 June 2017 Abstract Background: As the incidence of prostate cancer has, until recently, increased in most developed countries, the rates of prostate biopsies, required for histological diagnosis, will also have increased. Little is known about the physical after-effects of prostate biopsy outside randomised control trials. We investigate reports on the physical effect of prostate biopsy undertaken in men in routine practice. Methods: A self-completed questionnaire was given to men living in the Republic of Ireland (RoI) or Northern Ireland 4 to 6 weeks after prostate biopsy. Men were asked about whether they experienced specific physical after-effects postbiopsy (raised temperature/pain/ bleeding/erectile dysfunction/urinary retention) and, if so, their severity and duration, and any associated health care uses. Binomial and ordinal logistic regression was used to investigate factors associated with postbiopsy after-effects (presence/absence) and number of after- effects reported, respectively. Results: Postbiopsy after-effects were common with 88.1% of 335 respondents reporting at least 1 after-effect; 21% reported at least 3. The odds of increasing number of after-effects was over 2-fold in men with both intermediate (odds ratio [OR] ¼ 2.59, 95% CI: 1.52–4.42) and high (OR ¼ 2.52, 95% CI: 1.28–4.94) levels of health anxiety and for men who had had multiple previous biopsies (adjusted OR ¼ 2.02, 95% CI: 1.20–3.41). A total of 21.3% of men who experienced after-effects reported that they were worse than expected, 11.5% with after-effects reported contacting their doctor or local pharmacy, 14.6% contacted hospital services, and 3.1% of men with after-effects were admitted to hospital with an average stay of 5.4 nights (standard deviation ¼ 6.3). Conclusion: Physical after-effects following prostate biopsy in routine practice are common, and in some men, serious enough to warrant contacting hospital or community services. Men with increased health anxiety or who undergo multiple biopsies might benefit from additional support. r 2017 Elsevier Inc. All rights reserved. Keywords: Prostate; Biopsy; Physical; Questionnaire 1. Background Over the last 2 decades prostate cancer incidence rates have increased in developed countries [1] due to increased prostate specific antigen (PSA) testing [2], which in turn has led to more prostate biopsies being performed [3]. In the United Kingdom alone, there is an estimated 100,000 procedures per year [4]. Recognised early complications of biopsy include rectal bleeding, haematuria, and urinary retention with infections and sepsis listed among later occurring after-effects [5–9]. However, most data have accrued from men who have participated in randomised controlled trials [4,10] where the participants or health care received may not be typical of routine practice. Furthermore, previous research has mainly focussed on after-effects in men who had undergone their first prostate biopsy and who were http://dx.doi.org/10.1016/j.urolonc.2017.06.003 1078-1439/r 2017 Elsevier Inc. All rights reserved. L.S. held an unrestricted project grant, 2011 to 2012, from Sanofi- Aventis for research into patterns of treatment and survival for prostate cancer. * Corresponding author. Tel.: þ44-289-063-2618. E-mail address: E.Morgan@qub.ac.uk (E. Morgan). 1 Joint last authors.