Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and bleeding complications

Ultrasound guided transrectal biopsy of the prostate is the only viable method of diagnosing and histologically staging prostate cancer. It is, however, invasive. At best it is uncomfortable and often painful, occasionally almost intolerably so. There are also the uncommon but dangerous side affects of septicaemia, and the more common side effects of bleeding in the form of haematuria, haematoschezia and haemospermia. Various methods are used to reduce pain, with limited success. Antibiotic regimes have reduced, but not eliminated, septicaemia. Haemorrhage, however, remains a problem. Virtually all patients have haematuria on urine testing. Haemorrhage sufficient for the patient to notice occurs in over half of patients undergoing prostate biopsy. In the majority, it is a minor worry, but no more. A smaller number have haemorrhage that is sufficiently severe or prolonged that the patient seeks medical advice. It is only a very small minority that have haemorrhage, either urinary or rectal, of sufficient severity to warrant hospital admission. Nevertheless, the risk of haemorrhage is always a consideration when performing the procedure and it should always be fully discussed when obtaining consent. Patients who are anticoagulated or on aspirin