Objective Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after‐effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure‐related distress in men having prostate biopsies in routine clinical practice. Methods Men who had undergone prostate biopsy for follow‐up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in 6 centres in Ireland completed questionnaires. Biopsy‐related psychological distress was measured using the Impact of Event Scale. An Impact of Event Scale score ≥ 9 was considered significant biopsy‐related distress. Logistic regression was used to identify predictors of significant distress. Results Three hundred thirty‐five men completed questionnaires. Overall, 49% had significant biopsy‐related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negative result (35%; P < .001). In multivariable analyses, the odds of significant distress were 3 times higher in men with cancer (OR = 3.33, 95% CI, 1.83‐6.04) and more than twice as high in men without a definitive result (OR = 2.61, 95% CI, 1.43‐4.78) compared to men with a negative result. Men with intermediate (OR = 3.19, 95% CI, 1.85‐5.53) or high (OR = 7.10, 95% CI, 3.45‐14.57) health anxiety (propensity to worry about one's health) also had significantly increased odds of biopsy‐related distress. Conclusions Significant distress is common after prostatic biopsy. Some men, including those who are highly health anxious and those awaiting definitive results, may benefit from additional support around the time of and/or following prostate biopsy.