Magnetic Resonance Imaging in Hematospermia: Does It Increase Unnecessary Prostate Biopsy?

Hematospermia is an uncommon presentation of prostate cancer. Following the introduction of MRI for patients with hematospermia we evaluated its use and effect on prostate biopsy and cancer detection rates.

Analysis of patients attending our outpatient department over 2 years was undertaken. Diagnostic workup included digital rectal examination and PSA. Those with abnormal findings or persisting symptoms were offered prostate biopsy. In the second year MRI became available for patients with hematospermia. Abnormal MRI or persisting symptoms were offered biopsy. We compared the frequency of prostate biopsy and cancer detection in patients undergoing MRI and those not having imaging.

Forty-seven patients were referred with hematospermia. Nineteen patients did not undergo MRI; four received prostate biopsy with one adenocarcinoma found. Twenty-four patients had an MRI with 17 biopsies undertaken. Three biopsies revealed adenocarcinoma. In the MRI group 71% of patients underwent prostate biopsy but only 21% from the non-MRI group (p < 0.05). Prostate cancer detection rate in the MRI group was 18% whilst in the non-MRI group was 25% (p = 0.7).

Our findings indicate that caution should be used with MRI as it can lead to an increase in prostate biopsy with no change in cancer detection rate.