Patient-reported Pain, Discomfort, and Anxiety During Magnetic Resonance Imaging-targeted Prostate Biopsy

Overview

Journal Can Urol Assoc J

Specialty Urology

Date 2019 Dec 4

PMID 31793867

Citations 9

Authors

Gregory T Chesnut

Piotr Zareba

Daniel D Sjoberg

Maha Mamoor

Sigrid Carlsson

Taehyoung Lee

Jonathan Fainberg

Emily Vertosick

Michael Manasia

Mary Schoen

Behfar Ehdaie

Affiliations

Soon will be listed here.

Abstract

Introduction: The addition of targeted prostate biopsy to systemic biopsy impacts patient experience. We examined patient-reported pain, discomfort, anxiety, and tolerability among men undergoing magnetic resonance imaging (MRI)-targeted prostate biopsy in addition to transrectal ultrasound-guided systematic biopsy compared to those undergoing systematic biopsy alone.

Methods: All patients underwent transrectal systematic 14-core biopsies. Patients with regions of interest on MRI underwent additional targeted biopsies. All patients received equivalent periprostatic nerve block. Four single-item, standard, 11-point numerical rating scales evaluating pain, discomfort, anxiety, and tolerability were completed immediately after biopsy. Differences in means were compared using t-tests. Correlation between rated domains was tested using Spearman's correlation coefficient.

Results: Of 273 consecutive patients, 195 (71%) underwent targeted biopsy and 188 (69%) had undergone prior biopsy. In all men, the median score for pain and tolerability was 3, while the median score for discomfort and anxiety was 4. Pain was rated at 7 or above by 15% of patients. Moderate correlation between pain, discomfort, anxiety, and tolerability of repeat biopsy was observed (Spearman's ρ between 0.48 and 0.76). Compared to patients undergoing systematic biopsy alone, men who received both targeted and systematic biopsies reported higher anxiety scores (difference 1.2; 95% confidence interval [CI] 0.4-2.0; p=0.004) and discomfort (difference 1.0; 95% CI 0.3-1.7; p<0.001).

Conclusions: Patients undergoing targeted and systematic biopsies report more discomfort and anxiety than patients undergoing systematic biopsies alone. Absolute differences are small, and patients are willing to undergo repeat biopsy if advised. Interventions to reduce biopsy-related anxiety are needed.

Citing Articles

Risk Factors and Contemporary Management Options for Pain and Discomfort Experienced During a Prostate Biopsy.

Diaz G, Webb L, Rabil M, Lokeshwar S, Choksi A, Leapman M Curr Urol Rep. 2024; 25(10):243-252.

PMID: 38896314 DOI: 10.1007/s11934-024-01220-w.

Advanced prostate cancer diagnosed by bone metastasis biopsy immediately after initial negative prostate biopsy: a case report and literature review.

Liu M, Xie Z, Tang W, Liang G, Zhao Z, Wu T Front Oncol. 2024; 14:1365969.

PMID: 38800391 PMC: 11116681. DOI: 10.3389/fonc.2024.1365969.

Comparison of procedural anxiety and pain associated with conventional transrectal ultrasound prostate biopsy to magnetic resonance imaging-ultrasound fusion-guided biopsy: a prospective cohort trial.

Deivasigamani S, Adams E, Kotamarti S, Mottaghi M, Taha T, Aminsharifi A Prostate Cancer Prostatic Dis. 2023; 27(2):294-299.

PMID: 38001362 DOI: 10.1038/s41391-023-00760-5.

The Severity of Pain in Prostate Biopsy Depends on the Biopsy Sector.

Rempega G, Rajwa P, Kepinski M, Ryszawy J, Wojnarowicz J, Kowalik M J Pers Med. 2023; 13(3).

PMID: 36983612 PMC: 10057203. DOI: 10.3390/jpm13030431.

Prospective analysis of pain expectancy and experience during MR-fusion prostate biopsy: does reality match patients' expectancy?.

Krausewitz P, Schmeller H, Luetkens J, Dabir D, Ellinger J, Ritter M World J Urol. 2022; 40(9):2239-2244.

PMID: 35833972 PMC: 9427866. DOI: 10.1007/s00345-022-04083-3.

References

Mkinen T, Auvinen A, Hakama M, Tammela T . Acceptability and complications of prostate biopsy in population-based PSA screening versus routine clinical practice: a prospective, controlled study. Urology. 2002; 60(5):846-50. DOI: 10.1016/s0090-4295(02)01864-2. View

Robins D, Lipsky M, RoyChoudry A, Wenske S . Assessment of Discomfort and Pain in Patients Undergoing Fusion Magnetic Resonance Imaging-guided vs TRUS-guided Prostate Biopsy. Urology. 2018; 116:30-34. DOI: 10.1016/j.urology.2018.02.029. View

Naughton C, Ornstein D, Smith D, Catalona W . Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol. 1999; 163(1):168-71. View

Futterer J, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A . Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature. Eur Urol. 2015; 68(6):1045-53. DOI: 10.1016/j.eururo.2015.01.013. View

Dworkin R, Turk D, Farrar J, Haythornthwaite J, Jensen M, Katz N . Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2004; 113(1-2):9-19. DOI: 10.1016/j.pain.2004.09.012. View

Fourcade A, Payrard C, Tissot V, Perrouin-Verbe M, Demany N, Serey-Effeil S . The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer. Scand J Urol. 2018; 52(3):174-179. DOI: 10.1080/21681805.2018.1438509. View

Fell D, Derbyshire D, Maile C, Larsson I, Ellis R, Achola K . Measurement of plasma catecholamine concentrations. An assessment of anxiety. Br J Anaesth. 1985; 57(8):770-4. DOI: 10.1093/bja/57.8.770. View

Leibovici D, Zisman A, Siegel Y, Sella A, Kleinmann J, Lindner A . Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol. 2002; 167(2 Pt 1):563-5. DOI: 10.1016/S0022-5347(01)69086-4. View

Schoots I, Roobol M, Nieboer D, Bangma C, Steyerberg E, Hunink M . Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2014; 68(3):438-50. DOI: 10.1016/j.eururo.2014.11.037. View

10.

Hergan L, Kashefi C, Parsons J . Local anesthetic reduces pain associated with transrectal ultrasound-guided prostate biopsy: a meta-analysis. Urology. 2007; 69(3):520-5. DOI: 10.1016/j.urology.2006.12.005. View

11.

Zisman A, LEIBOVICI D, Kleinmann J, Siegel Y, Lindner A . The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol. 2001; 165(2):445-54. DOI: 10.1097/00005392-200102000-00023. View

12.

Ploussard G, Borgmann H, Briganti A, De Visschere P, Futterer J, Gandaglia G . Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies?. World J Urol. 2018; 37(2):243-251. DOI: 10.1007/s00345-018-2399-z. View

13.

Loeb S, Carter H, Berndt S, Ricker W, Schaeffer E . Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011; 186(5):1830-4. PMC: 9840843. DOI: 10.1016/j.juro.2011.06.057. View

14.

Kahriman G, Donmez H, Mavili E, Ozcan N, Yilmaz S, Kenan B . Transrectal ultrasound guided multi-core prostate biopsy: pain control: results of 106 patients. J Clin Ultrasound. 2011; 39(5):270-3. DOI: 10.1002/jcu.20777. View

15.

Sharp L, Morgan E, Drummond F, Gavin A . The psychological impact of prostate biopsy: Prevalence and predictors of procedure-related distress. Psychooncology. 2017; 27(2):500-507. DOI: 10.1002/pon.4521. View

16.

Moussa A, El-Shafei A, Diaz E, Gao T, Zaytoun O, Fareed K . Identification of the variables associated with pain during transrectal ultrasonography-guided prostate biopsy in the era of periprostatic nerve block: the role of transrectal probe configuration. BJU Int. 2013; 111(8):1281-6. DOI: 10.1111/j.1464-410X.2012.11689.x. View

17.

Chang S, Alberts G, Wells N, Smith Jr J, Cookson M . Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol. 2001; 166(6):2178-80. DOI: 10.1016/s0022-5347(05)65529-2. View

18.

Sarkar D . The Role of Multi-Parametric MRI and Fusion Biopsy for the Diagnosis of Prostate Cancer - A Systematic Review of Current Literature. Adv Exp Med Biol. 2018; 1095:111-123. DOI: 10.1007/978-3-319-95693-0_7. View

19.

Hodge K, McNeal J, Terris M, Stamey T . Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989; 142(1):71-4; discussion 74-5. DOI: 10.1016/s0022-5347(17)38664-0. View

20.

Loeb S, van den Heuvel S, Zhu X, Bangma C, Schroder F, Roobol M . Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012; 61(6):1110-4. DOI: 10.1016/j.eururo.2011.12.058. View