Introduction: Prostate biopsy (PBX) is being performed more often than ever before for the early detection of prostate cancer, but some patients may have febrile infectious complications after biopsy. The risk factors of infectious complications need to be considered. Methods: We investigated the pre-biopsy risk factors and febrile infectious complications in 120 patients who underwent PBX in our institution. The pre-biopsy risk factors set were prostate volume (≧40 ml), transitional zone (TZ) volume (≧20 ml), core number of biopsy (≧10 cores), and additional performance of TZ biopsy. We analyzed statistically the correlations between these risk factors and C-reactive protein and peripheral white blood cell (WBC) count elevation on day 1 and day 7 after biopsy. Results: Our results showed that a prostate volume ≧40 ml and a TZ volume ≧20 ml caused a significantly higher elevation of the C-reactive protein level compared with a prostate volume <40 ml (p = 0.0055 on day 1 and p = 0.0225 on day 7, respectively) on day 1 and day 7, and a TZ volume <20 ml (p = 0.0008) on day 1. Regarding WBC count, those patients with a prostate volume ≧40 ml and a TZ volume ≧20 ml had a tendency to have an elevated WBC count on day 1 compared with those patients with a prostate volume <40 ml and a TZ volume <20 ml, and however these changes were not significant. Conclusions: This study showed that a larger prostate volume and a larger TZ volume may possibly be risk factors in infectious complications after PBX, although we can perform additional TZ biopsy and increase biopsy core number safely if necessary.

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