***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy ( TRUS-PB ) . The true incidence of hemospermia , its duration and implication s are not well established . We performed a prospect i ve 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 BACKGROUND To describe a preparatory protocol for prostate biopsy consisting of prophylaxis based on a third-generation cephalosporin and suppository-type povidone-iodine . METHODS From January 2004 to May 2012 we review ed infective complications in 1,684 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy . All of the patients received prophylactic antibiotics through a single intravenous injection of a third-generation cephalosporin and cefixime at 100 mg PO for 5 d , with this regimen begun before biopsy , and were also given gynobetadine in a dose of 200 mg just before biopsy . Infectious complications were classified as sepsis , fever ( > 38 ° C ) without sepsis , and other clinical manifestations of infection . To evaluate the bactericidal effects of gynobetadine , we counted bacterial colonies prospect ively in cultures of rectal swab specimens from 150 patients who underwent TRUS-guided prostate biopsy . RESULTS Complications occurred in 46 of the patients ( 2.73 % ) , including infective complications in 11 ( 0.65 % ) patients and non-infective complications in 35 ( 2.08 % ) patients . Of the patients with infective complications , two had fever without sepsis , none had clinical urinary tract infections without fever , and none had sepsis . In prospect i ve in vitro investigations , the mean bacterial colony count before rectal preparation with an enema or rectal insertion of povidone-iodine suppository was 2.38 × 10(6 ) , whereas the colony count after a povidone-iodine rectal enema and subsequent biopsy was 1.81 × 10(3 ) and the colony count after rectal preparation with povidone-iodine suppository and subsequent biopsy was 8.1 × 10(2 ) ( all p<0.001 ) . CONCLUSIONS The administration of cephalosporin-based prophylactic antibiotics and the simple use of suppository-type povidone-iodine provided an excellent protocol for reducing infective complications of TRUS-guided prostate biopsy . The simplicity of use and cost effectiveness of gynobetadine were noteworthy Background Although transperineal ( TP ) prostate biopsy is growing in popularity , its safety has not been evaluated based on extensive studies . We prospect ively assessed the adverse events associated with transrectal ultrasound (TRUS)-guided TP 16-core prostate biopsy at a single institution . Patients and methods We enrolled 2,086 males who underwent first-time TRUS-guided TP prostate biopsy under lumbar spinal anesthesia at Chiba Cancer Center between 2009 and 2013 . Eight adverse events were assessed prospect ively using a purpose - design ed question naire . The prevalence and duration of all adverse events were evaluated . We performed subgroup analyses for hematuria and urinary retention in relation to clinical factors . Results Question naires were collected from 1,663 cases ( 79.7 % ) . The cancer detection rate was 53.5 % in all patients . The prevalence and duration of complications were as follows : hematuria , 73.4 % and 4.51 ± 2.88 days ; perineal bleeding , 7.1 % and 2.20 ± 2.24 days ; hematospermia 14.4 % ; dysuria , 15.7 % and 3.12 ± 2.71 days ; urinary tract pain , 49.5 % and 2.43 ± 2.08 days ; perineal pain , 35.5 % and 3.53 ± 2.59 days ; fever ≥37 ° C , 1.7 % and 1.79 ± 1.72 days ; and headache , 22.1 % and 3.40 ± 2.10 days . Seventeen patients ( 1.1 % ) required indwelling urethral catheterization for grade 2 urinary retention . Pre-biopsy International Prostate Symptom Score ( p = 0.014 ) was an independent related factor for hematuria . Prostate volume ( p = 0.001 ) was an independent related factor for grade 2 urinary retention . Conclusions TRUS-guided TP prostate biopsy under lumbar spinal anesthesia can be performed safely with only minor adverse events PURPOSE We evaluated the effect of intracapsular anesthesia and periprostatic nerve block during transrectal ultrasound guided prostate biopsy . MATERIAL S AND METHODS In a prospect i ve , r and omized , double-blind , placebo controlled study 152 consecutive patients were r and omized into 3 groups . Group 1 of 41 patients was administered intraprostatic local anesthesia into the right and left sides with a total of 2 ml 1 % lidocaine and a periprostatic injection of 2 ml saline later .  Group 2 of 49 patients was administered intraprostatic injection of 2 ml saline , followed by periprostatic local anesthesia with 2 ml 1 % lidocaine . Group 3 of 62 patients received intraprostatic and periprostatic local anesthesia with 2 ml 1 % lidocaine . Patients were asked to grade the pain level using a 10-point linear visual analog pain scale 1 ) when the transrectal ultrasound probe was inserted , 2 ) during anesthesia , 3 ) during biopsy and 4 ) 20 minutes after biopsy . One-way ANOVA and the Kruskal-Wallis test with the Tukey post hoc test were used to compare patient characteristics and pain scale responses among the 3 groups . RESULTS No major complications , including sepsis and severe rectal bleeding , were noted in any patient . There were statistically significant differences in pain scores among groups 1 to 3 during anesthesia ( mean + /- SD 5.6 + /- 2.5 , 6.7 + /- 2.3 and 4.9 + /- 2.1 , p = 0.003 ) and during biopsy ( 4.3 + /- 2.7 , 4.5 + /- 2.6 and 2.7 + /- 2.1 , respectively , p = 0.032 ) . There were no differences in pain scores among the 3 groups during probe insertion ( p = 0.39 ) . CONCLUSIONS A combination of intracapsular anesthesia and periprostatic nerve block is an effective and useful technique that is well tolerated by the patient . It decreases the level of pain and discomfort associated with the prostatic biopsy procedure Purpose To compare the antibiotic prophylaxis based on quinolone administered orally with a combination of cephalosporin administered periprostatically and a fluoroquinolone orally , in terms of post-prostate bioptic infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy ( TRUS gpb ) . Methods In a prospect i ve , r and omized , double-blind study , 150 consecutive patients were r and omized to receive 10 ml lidocaine 1 % in Group A and ceftriaxone 1 g diluted in a solution of 10 ml of lidocaine 1 % in Group B , before TRUS gpb . All signed the informed consent . The men were asked to grade the pain using a ten points visual analogue scale close after TRUS gpb . In a telephone interview at 3 and 6 days , they were asked about early and late complications , assessing rectal bleeding , urinary retection , fewer , haematuria , urethral bleeding and hematospermia . Results Of the 150 men enrolled , 135 , 70 in Groups A and 65 in Group B , completed the study . Four men ( 5.7 % ) in Group A developed sepsis after TRUS gpb requiring hospital admission and intravenous antibiotic treatment , while none in Group B. Escherichia coli was the only organism isolated . The mean pain score was 2.76 ± 1.69 and 1.73 ± 1.26 for Group A and B , respectively ( p = 0.08 ) . Complications , evaluated at 3 and 6 days after the procedure through a telephone interview , were similar in both Groups . Conclusions The antibiotic prophylaxis based on the combination of ceftriaxone administered periprostatically and ciprofloxacin orally is able to offer a best control on infections caused by fluoroquinolone-resistant E. coli BACKGROUND The complications of  prostate needle biopsy ( PNB )  are important when considering the benefits and harms of prostate cancer screening . Studies from the United States and Canada have recently reported increasing numbers of hospitalizations for infectious complications after PNB . OBJECTIVE Examine the risk of infectious complications and hospital admissions after PNB in a European screening trial . DESIGN , SETTING , AND PARTICIPANTS From 1993 to 2011 , 10 474 PNBs were performed in the European R and omized Study of Screening for Prostate Cancer ( Rotterdam section ) . Prophylaxis originally consisted of trimethoprim-sulfamethoxazole . Beginning in 2008 , it was changed to ciprofloxacin . MEASUREMENTS Febrile complications and hospital admissions were assessed by question naires 2 wk after PNB . Logistic regression was used to identify risk factors for biopsy-related fever and hospital admission . RESULTS AND LIMITATIONS Fever and hospital admission were reported on 392 of 9241 question naires ( 4.2 % ) and 78 of 9198 question naires ( 0.8 % ) , respectively . Although most fevers were managed on an outpatient basis , 81 % of hospital admissions were for infection . Of the 56 available blood cultures , 34 were positive with Escherichia coli as the predominant organism . On multivariable analysis , prostate enlargement and diabetes were significantly associated with an increased risk of fever after PNB , whereas later year of biopsy was the only factor significantly associated with an increased risk of hospital admission . CONCLUSIONS In a European screening trial , < 5 % PNBs result ed in febrile complications . Significant risk factors included diabetes and prostatic enlargement . Although most fevers were managed on an outpatient basis , infection remained the leading cause of hospital admission after PNB . Consistent with prior international reports , the frequency of hospital admissions after PNB significantly increased over time . Nevertheless , the absolute frequency of hospital admissions related to PNB was low and should not dissuade healthy men who would benefit from early prostate cancer diagnosis from undergoing biopsy when clinical ly indicated BACKGROUND A prior study showed significant antibiotic resistance to quinolone in our population . In this study we aim ed to evaluate and compare the efficacy of a single versus a combined prophylactic antibiotic regimen  before transrectal ultrasound-guided prostate biopsy ( TRUGPB ) . METHODS A prospect i ve r and omized study was conducted at a university hospital . Patients undergoing TRUGPB were r and omized into an amoxicillin-clavulanate alone ( 1 mg ; one dose before and two doses after biopsy ) or an amoxicillin-clavulanate + ciprofloxacin group ( 250 mg ; one dose before and two doses after biopsy ) . Patients were surveyed for infection symptoms by phone on days 3 and 30 after TRUGPB . We defined an infective complication as the occurrence of symptoms including fever , chills or rigor within 30 days after prostate biopsy , requiring medical treatment or hospitalization , aided by a territory-wide electronic medical record system . RESULTS Between November 2007 and July 2009 , 367 patients were r and omized to either amoxicillin-clavulanate alone or amoxicillin-clavulanate + ciprofloxacin group . The infection rates after TRUGPB were 3.91 % in the former group ( 7 out of 179 patients ) versus 0.53 % ( 1 out of 188 patients ) in the latter . Sixty-three percent ( 5/8 ) of patients with infective complications needed hospitalization . There was no intensive care unit admission or mortality during the study period . CONCLUSIONS Combining prophylactic antibiotics with amoxicillin-clavulanate + ciprofloxacin significantly reduced the incidence of infective complications after TRUGPB . We recommended a combination regimen , 
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EVIDENCE SYNTHESIS The most frequent complication after PB was minor and self-limiting bleeding ( hematuria and hematospermia ) , regardless of the biopsy approach .
Occurrence of rectal bleeding was comparable for traditional TRUS-guided and image-guided PBs .
Almost 25 % of patients experienced lower urinary tract symptoms , but only a few had urinary retention , with higher rates after a transperineal approach .
Temporary erectile dysfunction was not negligible , with a return to baseline after 1 - 6 mo .
The incidence of infective complications is increasing , with higher rates among men with medical comorbidities and older age .
Transperineal and in-bore MRI-targeted biopsy may reduce the risk of severe infectious complications .
Mortality after PB is uncommon , regardless of biopsy technique .
Complications after PB are frequent but often self-limiting .