Problematic Symptoms After Prostate Biopsy Associated With Anxiety


Key Points

  • Overall levels of anxiety were low across all time points except at 35 days among patients receiving a cancer diagnosis.
  • Levels of anxiety were increased among men with problematic postbiopsy symptoms compared with those in men with symptoms not reported as problematic, including among men with negative biopsy results.

In a study reported in the Journal of Clinical Oncology, Julia Wade, PhD, of Bristol University, United Kingdom, and colleagues assessed the psychological impact of prostate biopsy. They found that postbiopsy symptoms can be associated with increased anxiety, independent of anxiety associated with a diagnosis of prostate cancer.

Study Details

The study involved 1,147 asymptomatic men from the Prostate Testing for Cancer and Treatment Trial who were recommended for prostate biopsy on the basis of prostate-specific antigen testing and who completed questionnaires assessing physical and psychological harms after biopsy in the Prostate Biopsy Effects (PRoBE) study. Psychological effects were assessed using the Hospital Anxiety and Depression Scale (HADS).

HADS questionnaires were completed by 99.7% of men at biopsy, 95.0% at 7 days, and 88.6% at 35 days. Overall, 471 men had negative biopsy, 405 had a diagnosis of cancer, and 270 had uncertain results.

Depression scores were low at all time points irrespective of diagnoses. In the total population, anxiety scores were low and stable for most patients, with 3% to 7% having scores indicative of anxiety at different time points. However, among patients with a diagnosis of cancer, 13% had increased anxiety at day 35, after diagnosis was known.

Anxiety Associated With Problematic Symptoms

Anxiety was also more common among men reporting problematic postbiopsy symptoms. Among men with negative biopsy, 38% experienced pain, 11% fever, 12% shivers, 65% hematuria, 30% hematochezia, and 84% hemoejaculate within 7 days after biopsy. Of these, 11% with pain, 22% with fever, 18% with shivers, 9% with hematuria, 6% with hematochezia, and 27% with hemoejaculate reported the symptoms as a moderate or major problem.

Among those reporting symptoms as a moderate/major problem, 37% of those with pain, 30% with fever, 33% with shivers, 29% with hematuria, 43% with hematochezia, and 10% with hemoejaculate had HADS scores indicating increased anxiety. Mean anxiety scores were significantly higher among all men with problematic symptoms vs men without problematic symptoms for those with pain (P < .001), shivers (P = .020), hematuria (P < .001), hematochezia (P < .001), and hemoejaculate (P < .001).

At 35 days after biopsy, the proportions of patients with negative biopsy reporting symptoms and reporting symptoms as a moderate/major problem were similar to those at 7 days, but fewer patients reported anxiety in association with the bothersome symptoms: 9% of those with pain, 25% with fever, 14% with shivers, 12% with hematuria, 20% with hematochezia, and 7% with hemoejaculate. Mean anxiety scores were significantly higher for men with problematic symptoms vs men without problematic symptoms only for hematuria (P = .034) and hemoejaculate (P = .017).  

Similar relationships between problematic symptoms and increased anxiety were found among patients with a cancer diagnosis and all patients combined. However, men with problematic symptoms and an uncertain diagnosis at day 35 continued to exhibit elevated anxiety scores.

The investigators concluded, “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.”

Jenny Donovan, PhD, of the University of Bristol is the corresponding author for the Journal of Clinical Oncology article.

The ProBE study was funded by the UK Prostate Cancer Risk, Management Group.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.