Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy

Abstract

Objectives: Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. Materials and Methods: Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. Results: 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). Conclusion: FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.

Effect of different manipulations on serum PSA in patients with benign prostatic hyperplasia.

“…Although there are few studies available which follow the serum Prostate Specific Antigen level till one month, but, all studies stated that there is significant rise in serum Prostate Specific Antigen level after Transurethral Resection of Prostate. 19 Our study also showed the same results. There is significant rise in serum Prostate Specific Antigen level after Transurethral Resection of Prostate.…”

Risk factors associated with pain in fusion prostate biopsy

“…Comparison of FPB and SPB with regard to pain intensity has been conducted in several previous studies. 7 , 23 In those studies, however, no evaluation was performed on the direct relationship between the number of cores/biopsy time and pain. Moreover, in those studies, similar pain scores were reported for FPB and SPB although FPB requires a higher number of target cores and longer time when compared with SPB.…”

“… 5 , 6 In CB, as expected, the number of cores sampled per target and the total biopsy time are increased. 7 On the other hand, the mpMRI images routinely obtained before biopsy provide extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. 8 , 9 …”

Effect of Prolonged Duration of Transrectal Ultrasound-Guided Biopsy of the Prostate and Pre-Procedure Anxiety on Pain in Patients without Anesthesia

“… 21 However, the number of core biopsy samples did not predict overall pain after the procedure was complete, in contrast to the predictive value of a long duration of TR-PBx. Demirtaş et al 22 reported no significant difference between patients who underwent multiparametric magnetic resonance imaging-guided fusion prostate biopsy and those who underwent the standard TR-PBx with regard to visual analog pain scale score (p = 0.070), although the number of cores taken in the patients who underwent the former procedure was significantly higher than that in the patients who underwent the latter procedure. Furthermore, Arsov et al 20 reported that procedural pain in patients who received magnetic resonance imaging-guided in-bore biopsy (mean pain score ± standard deviation [SD], 2.95 ± 2.15) with a mean number of 5.6 cores and mean procedure time of 42 minutes was significantly higher (p < 0.001) than those values for patients who received magnetic resonance imaging/ultrasound fusion-guided plus systematic biopsy (mean pain score ± SD, 1.95 ± 1.56) with a mean number of 17.4 cores and mean procedure time of 28 minutes.…”