Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy? A prospective, randomized trial

Abstract

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group (94 patients, Group A) received a transperineal prostate biopsy using a 16 G-needle and the second group (93 patients, Group B) underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale (VAS) and facial expression scale (FES) were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen (PSA) and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18-and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible procedure in terms of pain and complication rates. Further studies with larger patient populations are required to assess whether or not this procedure can improve prostate cancer detection rates.

Prostate Biopsy Quality Is Independent of Needle Size: A Randomized Single-Center Prospective Study

“…A risk of about 1% of severe hemorrhage requiring hospitalization was also decrypted by Ghani et al [16]. Moreover, Saredi et al [4] did not observe any difference in terms of morbidity between 16- and 18-gauge needles except in the transperineal PBx scheme.…”

“…On the other hand, it can potentially carry a higher risk of procedure-related complications. Few studies to date have addressed this specific issue [4,5]. …”

Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized and Controlled Trial

“…When asked whether the patients agreed to accept repeated biopsy, 82% of them answered “yes” 33 . On the contrary, Saredi et al found the VAS score was as high as 4.09 during anesthesia when performing TPBx 34 . In addition, mild pain was seen more frequently after biopsy in the TPBx group.…”

Transperineal prostate biopsies for diagnosis of prostate cancer are well tolerated: a prospective study using patient-reported outcome measures

“…TP biopsies might have a higher rate of cancer detection,10 particularly at the apex and anteriorly, with significantly lower rates of sepsis,11 but usually require a general anesthetic (GA) 1213. With the increasing use of multiparametric magnetic resonance imaging (MRI), integrated MRI-TRUS fusion biopsies are able to improve detection of significant prostate cancer whether by the transrectal14 or TP route 15…”