Background: Incidence of prostate cancer is increasing as opportunistic screening becomes widespread and life expectancy rises. Despite screening availability, research reveals conflicting results on medical outcomes, for example, disease specific mortality. However the gold standard in early diagnosis of potentially curable organ confined prostate cancer is transrectal ultrasound-guided systematic prostate biopsy (TRUS-BX). While focus has been given to medical sequalae there is a paucity of research on the psychological impact of biopsy. Awaiting biopsy may be inherently stressful but no studies to date, have assessed men's perception of stress and its impact on emotional response. This study, therefore, examines the role of stress and also personal resources namely, self-efficacy and sense of coherence in emotional adjustment in men awaiting a prostate biopsy.Methods: Men attending a Rapid Access Prostate Cancer Clinic for a transrectal prostate biopsy (N = 114) participated in the study. They completed self report questionnaires on perceived stress (PSS), generalised self-efficacy (GSES), and sense of coherence (SOC). Adjustment was measured by the Profile of Mood States (POMS-B) which assesses tension, depression, anger, fatigue, confusion and vigour.Results: Hierarchical regression analyses demonstrated that the set of predictors accounted for 17%-34% of variance across six mood states and predicted 46% of total mood disturbance. Perceived stress explained variance on all domains (11%-26%) with high stress linked to poor functioning.Conclusion: Perceived stress was the strongest and most consistent predictor of emotional adjustment. This is an important finding as stress appraisal has not been examined previously in this context and suggests that stress management is an important target to enhance emotional wellbeing of men attending for a prostate biopsy.