Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study


Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy (TRUS-PB). The true incidence of hemospermia, its duration and implications are not well established. We performed a prospective observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution. Sixty-three eligible men were included in the study. Most men (84%) undergoing TRUS-PB, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 3.5 (±1.7) weeks. The number of ejaculations before the complete resolution of hemospermia was 8 (±6.7). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Schroder FH, Bangma CH . The European Randomized Study of Screening for Prostate Cancer (ERSPC). Br J Urol 1997; 79 (Suppl 1): 68–71.

    Article  Google Scholar 

  2. Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001; 166: 856–860.

    Article  CAS  Google Scholar 

  3. Hodge KK, McNeal JE, Stamey TA . Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol 1989; 142: 66–70.

    Article  CAS  Google Scholar 

  4. Stricker HJ, Ruddock LJ, Wan J, Belville WD . Detection of non-palpable prostate cancer. A mathematical and laboratory model. Br J Urol 1993; 71: 43–46.

    Article  CAS  Google Scholar 

  5. Presti Jr JC, Chang JJ, Bhargava V, Shinohara K . The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 2000; 163: 163–166; discussion 166–167.

    Article  Google Scholar 

  6. Naughton CK, Ornstein DK, Smith DS, Catalona WJ . Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol 2000; 163: 168–171.

    Article  CAS  Google Scholar 

  7. Rodriguez LV, Terris MK . Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol 1998; 160: 2115–2120.

    Article  CAS  Google Scholar 

  8. Aus G, Hermansson CG, Hugosson J, Pedersen KV . Transrectal ultrasound examination of the prostate: complications and acceptance by patients. Br J Urol 1993; 71: 457–459.

    Article  CAS  Google Scholar 

  9. Collins GN, Lloyd SN, Hehir M, McKelvie GB . Multiple transrectal ultrasound-guided prostatic biopsies – true morbidity and patient acceptance. Br J Urol 1993; 71: 460–463.

    Article  CAS  Google Scholar 

  10. Gustafsson O, Norming U, Nyman CR, Ohstrom M . Complications following combined transrectal aspiration and core biopsy of the prostate. Scand J Urol Nephrol 1990; 24: 249–251.

    CAS  PubMed  Google Scholar 

  11. Thompson PM, Pryor JP, Williams JP, Eyers DE, Dulake C, Scully MF et al. The problem of infection after prostatic biopsy: the case for the transperineal approach. Br J Urol 1982; 54: 736–740.

    Article  CAS  Google Scholar 

  12. Thompson PM, Talbot RW, Packham DA, Dulake C . Transrectal biopsy of the prostate and bacteraemia. Br J Surg 1980; 67: 127–128.

    Article  CAS  Google Scholar 

  13. Djavan B, Zlotta A, Kratzik C, Remzi M, Seitz C, Schulman CC et al. PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/ml. Urology 1999; 54: 517–522.

    Article  CAS  Google Scholar 

  14. Djavan B, Zlotta AR, Byttebier G, Shariat S, Omar M, Schulman CC et al. Prostate specific antigen density of the transition zone for early detection of prostate cancer. J Urol 1998; 160: 411–418; discussion 418–419.

    Article  CAS  Google Scholar 

  15. Brawer MK, Chetner MP . Ultrasonography of the Prostate and Biopsy. W.B. Saunders Co: Philadelphia, 1998, pp 2506–2518.

    Google Scholar 

  16. Djavan B, Zlotta A, Remzi M, Ghawidel K, Basharkhah A, Schulman CC et al. Optimal predictors of prostate cancer on repeat Prostate Biopsy: a prospective study of 1051 men. J Urol 2000; 163: 1144–1148; discussion 1148–1149.

    Article  CAS  Google Scholar 

  17. Munkel witz R, Krasnokutsky S, Lie J, Shah SM, Bayshtok J, Khan SA . Current perspectives on hematospermia: a review. J Androl 1997; 18: 6–14.

    CAS  PubMed  Google Scholar 

  18. Kumar P, Kapoor S, Nargund V . Haematospermia – a systematic review. Ann R Coll Surg Engl 2006; 88: 339–342.

    Article  Google Scholar 

  19. Han M, Brannigan RE, Antenor JA, Roehl KA, Catalona WJ . Association of hemospermia with prostate cancer. J Urol 2004; 172: 2189–2192.

    Article  Google Scholar 

  20. Bihrle R, Foster RS, Sanghvi NT, Donohue JP, Hood PJ . High intensity focused ultrasound for the treatment of benign prostatic hyperplasia: early United States clinical experience. J Urol 1994; 151: 1271–1275.

    Article  CAS  Google Scholar 

  21. Jones DJ . Haemospermia: a prospective study. Br J Urol 1991; 67: 88–90.

    Article  CAS  Google Scholar 

  22. Torp-Pedersen S, Lee F, Littrup PJ, Siders DB, Kumasaka GH, Solomon MH et al. Transrectal biopsy of the prostate guided with transrectal US: longitudinal and multiplanar scanning. Radiology 1989; 170: 23–27.

    Article  CAS  Google Scholar 

  23. de la Taille A, Antiphon P, Salomon L, Cherfan M, Porcher R, Hoznek A et al. Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology 2003; 61: 1181–1186.

    Article  Google Scholar 

  24. Mkinen T, Auvinen A, Hakama M, Stenman UH, Tammela TL . Acceptability and complications of prostate biopsy in population-based PSA screening versus routine clinical practice: a prospective, controlled study. Urology 2002; 60: 846–850.

    Article  Google Scholar 

  25. Rietbergen JB, Kruger AE, Kranse R, Schroder FH . Complications of transrectal ultrasound-guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk factors within a population-based screening program. Urology 1997; 49: 875–880.

    Article  CAS  Google Scholar 

  26. Clements R, Aideyan OU, Griffiths GJ, Peeling WB . Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol 1993; 47: 125–126.

    Article  CAS  Google Scholar 

  27. Ghani KR, Dundas D, Patel U . Bleeding after transrectal ultrasonography-guided prostate biopsy: a study of 7-day morbidity after a six-, eight- and 12-core biopsy protocol. BJU Int 2004; 94: 1014–1020.

    Article  Google Scholar 

  28. Wammack R, Djavan B, Remzi M, Susani M, Marberger M . Morbidity of transrectal ultrasound-guided prostate needle biopsy in patients receiving immunosuppression. Urology 2001; 58: 1004–1007.

    Article  CAS  Google Scholar 

  29. Maan Z, Cutting CW, Patel U, Kerry S, Pietrzak P, Perry MJ et al. Morbidity of transrectal ultrasonography-guided prostate biopsies in patients after the continued use of low-dose aspirin. BJU Int 2003; 91: 798–800.

    Article  CAS  Google Scholar 

Download references


This work was financially supported by Jackson Memorial Hospital Foundation and Mr Vincent A Rodriguez.

Author information

Authors and Affiliations


Corresponding author

Correspondence to M Manoharan.

Additional information

Conflict of interest

None declared.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Manoharan, M., Ayyathurai, R., Nieder, A. et al. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 10, 283–287 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • hemospermia
  • prostate biopsy
  • transrectal ultrasound

This article is cited by


Quick links