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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

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Background

Prostate cancer (PCa) diagnosis relies on biopsies, with transrectal ultrasound (TRUS) biopsies being common. Fusion biopsy (FB) offers improved diagnostic accuracy, but the pain and anxiety experienced by patients during biopsies is often overlooked. This study aims to compare pain and anxiety levels between standard TRUS-guided biopsy (STB) and systematic plus MRI/US fusion biopsy (STB + FB).

Materials and methods

The study involved adult men undergoing biopsies, receiving identical peri-procedural care, including 2% lidocaine jelly in the rectum and subsequent 1% lidocaine injections (10cc per side) into the prostate-seminal vesicle junction and prostatic apical areas bilaterally. The biopsy technique was chosen based on clinical and imaging findings. Pre- and post-biopsy anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire, categorized as mild (20–37), moderate (38–44), or severe (45–80). Post-biopsy pain was evaluated on a numerical rating scale, ranging from 0 to 10.

Results

Of the 165 patients, 99 underwent STB, and 66 underwent STB + FB. No significant differences were observed in age, race, prostate-specific antigen, prostate volume, or prior biopsies between the groups. The STB + FB group had more biopsy cores taken (16.2 vs. 12, p = 0.001) and a longer procedure time (23 vs. 10 min, p = 0.001). STB biopsy patients experienced lower post-procedural anxiety compared to STB + FB, with a mean difference of −7 (p = 0.001, d = 0.92). In the STB + FB group, 89% experienced severe post-procedural anxiety compared to 59% in STB (p = 0.002). There was no significant difference in post-procedural pain (p = 0.7). Patients with prior biopsies had significantly higher STAI(S) anxiety scores (p = 0.005), and the number of prior biopsies correlated with anxiety severity (p = 0.04) in STB + FB group.

Conclusion

In summary, STB + FB group demonstrated higher post-procedural anxiety levels than the STB group, with no difference in pain levels. Additionally, patients with a history of repeat biopsies were more likely to exhibit higher STAI(S) anxiety scores.

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Fig. 1: Difference in post-procedural anxiety outcomes among biopsy techniques.
Fig. 2: Difference in severity of post-procedural anxiety levels between biopsy techniques.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request and with permission of Duke Health.

References

  1. Descotes J-L. Diagnosis of prostate cancer. Asian J Urol. 2019;6:129–36.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chesnut GT, Zareba P, Sjoberg DD, Mamoor M, Carlsson S, Lee T, et al. Patient-reported pain, discomfort, and anxiety during magnetic resonance imaging-targeted prostate biopsy. Can Urol Assoc J. 2020;14:E202–e8.

    PubMed  Google Scholar 

  3. Garcia-Reyes K, Passoni NM, Palmeri ML, Kauffman CR, Choudhury KR, Polascik TJ, et al. Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis. Abdom Imaging. 2015;40:134–42.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. 2020;382:917–28.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Elkhoury FF, Felker ER, Kwan L, Sisk AE, Delfin M, Natarajan S, et al. Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive: the prospective assessment of image registration in the diagnosis of prostate cancer (PAIREDCAP) study. JAMA Surg. 2019;154:811–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dorfinger J, Ponholzer A, Stolzlechner M, Lenart S, Baltzer P, Toepker M. MRI/ultrasound fusion biopsy of the prostate compared to systematic prostate biopsy - Effectiveness and accuracy of a combined approach in daily clinical practice. Eur J Radio. 2022;154:110432.

    Article  Google Scholar 

  7. Spielberger C. State-trait anxiety inventory: bibliography. In: Palo Alto, editor. 2nd edn. CA: Consulting Psychologists Press; 1989.

  8. Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int. 1985;5:145–8.

    Article  PubMed  CAS  Google Scholar 

  9. Kayikcioglu O, Bilgin S, Seymenoglu G, Deveci A. State and trait anxiety scores of patients receiving intravitreal injections. Biomed Hub. 2017;2:1–5.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37:378–81.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Boonstra AM, Stewart RE, Köke AJ, Oosterwijk RF, Swaan JL, Schreurs KM, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016;7:1466.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Assel M, Sjoberg D, Elders A, Wang X, Huo D, Botchway A, et al. Guidelines for reporting of statistics for clinical research in urology. J Urol. 2019;201:595–604.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989;142:71–4.

    Article  PubMed  CAS  Google Scholar 

  14. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011;186:1830–4.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Anastasiadis E, van der Meulen J, Emberton M. Hospital admissions after transrectal ultrasound-guided biopsy of the prostate in men diagnosed with prostate cancer: a database analysis in England. Int J Urol. 2015;22:181–6.

    Article  PubMed  Google Scholar 

  16. Sharp L, Morgan E, Drummond FJ, Gavin A. The psychological impact of prostate biopsy: prevalence and predictors of procedure-related distress. Psychooncology. 2018;27:500–7.

    Article  PubMed  Google Scholar 

  17. Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol. 2016;12:2513–29.

    Article  PubMed  CAS  Google Scholar 

  18. Sonmez G, Tombul ST, Demirtas T, Demirtas A. Risk factors associated with pain in fusion prostate biopsy. Prostate Int. 2020;8:185–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cebeci O, Ozkan A. An evaluation of factors affecting pain during transrectal ultrasonographic prostate biopsy: a real-life scenario in a retrospective cohort study. PeerJ. 2021;9:e12144.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Demirtaş A, Sönmez G, Tombul ŞT, Demirtaş T. Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol. 2020;46:557–62.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Arsov C, Rabenalt R, Blondin D, Quentin M, Hiester A, Godehardt E, et al. Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol. 2015;68:713–20.

    Article  PubMed  Google Scholar 

  22. Krausewitz P, Schmeller H, Luetkens J, Dabir D, Ellinger J, Ritter M, et al. Prospective analysis of pain expectancy and experience during MR-fusion prostate biopsy: does reality match patients’ expectancy? World J Urol. 2022;40:2239–44.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Tsivian M, Qi P, Kimura M, Chen VH, Chen SH, Gan TJ, et al. The effect of noise-cancelling headphones or music on pain perception and anxiety in men undergoing transrectal prostate biopsy. Urology. 2012;79:32–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA

    Sriram Deivasigamani, Eric S. Adams, Srinath Kotamarti, Terek Taha, Ali Aminsharifi, Zoe Michael & Thomas J. Polascik

  2. Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA

    Mahdi Mottaghi, Zoe Michael & Thomas J. Polascik

  3. Ziv Medical Center, Safed, Israel

    Terek Taha

  4. Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Ali Aminsharifi

  5. Department of Urology, Lille University, Lille, France

    Denis Seguier

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  1. Sriram Deivasigamani
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  9. Thomas J. Polascik
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Contributions

SD: investigation, formal analysis, writing—original draft. ESA: investigation, formal analysis, writing-original draft. SK: investigation, writing-review & editing. MM: writing-review & editing. TT: writing-review & editing. AA: resources, writing-review & editing. ZM: data curation; writing-review & editing. TJP: conceptualization, methodology, validation and supervision.

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Correspondence to Sriram Deivasigamani.

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The authors declare no competing interests.

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Duke Health institutional review board approved study, protocol no. Pro00100268 with the waiver of consent.

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Deivasigamani, S., Adams, E.S., Kotamarti, S. et al. 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. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00760-5

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