Evaluation of pain of transperineal prostate biopsy under local anaesthesia
Authors:
Jiří Stejskal; Vanda Adamcová; Roman Zachoval
Authors‘ workplace:
Urologická klinika 3. lékařské fakulty a Fakultní Thomayerovy nemocnice v Praze
Published in:
Ces Urol 2022; 26(3): 186-192
Category:
Original Articles
Overview
Aim: The goal of the analysis is to evaluate patient reported pain during transperineal prostate biopsy (TPBxP) under local anaesthesia (LA).
Methods: We evaluated 55 patients who had a TPBxP under LA comprising 26 first and 29 repeated biopsies. On average 15 cores were obtained in each patient (12–18). The local anaesthesia was administered using 50cc of mesocaine applied to the perineal skin and prostate apex. No intravenous or oral analgesics were used. The patients reported the painfulness of both local anaesthesia and prostate biopsy using a scale of 1 (no pain) to 10 (highest pain imaginable). The data were then correlated with the patients’ age, prostate size, PSA level and the number of taken biopsy cores.
Results: The mean patient age was 66.85 years (54–78), the mean PSA was 10.11ng/ml (0.66 – 53.6), and the average prostate size was 46cc (17–126). The mean patient reported pain was 2,04 (1–7, median 2) for the application of the LA and 4.05 (1–7, median 4) for the biopsy. There was a positive correlation between the application of LA and the biopsy itself. Furthermore, there was a negative correlation between patient age and the reported painfulness of TPBxP.
Conclusion: TPBxP is reasonably well tolerated by patients. The biopsy itself is more painful than the application of LA. Older patients tend to tolerate the procedure better. The PSA level, prostate size and the number of biopsy cores have no effect on the patient reported pain.
Keywords:
prostate cancer – Pain – transperineal prostate biopsy – local anaesthesia
Sources
1. Grummet JP, Weerakoon M, Huang S, et al. Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int. 2014; 114(3): 384–8.
2. Eldred‑Evans D, Kasivisvanathan V, Khan F, et al. The Use of Transperineal Sector Biopsy as A First‑Line Biopsy Strategy: A Multi‑Institutional Analysis of Clinical Outcomes and Complications. Urol J. 2016 10; 13(5): 2849–55.
3. Berry B, Parry MG, Sujenthiran A, et al. Comparison of complications after transrectal and transperineal prostate biopsy: a national population‑based study. BJU Int. 2020; 126(1): 97–103.
4. Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta‑analysis. World J Surg Oncol. 2019; 13: 17(1):31.
5. Pradere B, Veeratterapillay R, Dimitropoulos K, et al. Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta‑Analysis. J Urol. 2021; 205(3): 653–63.
6. Pilatz A, Veeratterapillay R, Köves B, et al. Update on Strategies to Reduce Infectious Complications After Prostate Biopsy. Eur Urol Focus. 2019; 5(1): 20–8.
7. Stefanova V, Buckley R, Flax S, et al. Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability. J Urol. 2019; 201(6): 1121–6.
8. Tu X, Liu Z, Chang T, et al. Transperineal Magnetic Resonance Imaging‑Targeted Biopsy May Perform Better Than Transrectal Route in the Detection of Clinically Significant Prostate Cancer: Systematic Review and Meta‑analysis. Clin Genitourin Cancer. 2019; 17(5): e860–70.
9. Rai BP, Mayerhofer C, Somani BK, et al. Magnetic Resonance Imaging/Ultrasound Fusion‑guided Transperineal Versus Magnetic Resonance Imaging/Ultrasound Fusion‑guided Transrectal Prostate Biopsy – A Systematic Review. Eur Urol Oncol. 2021; 4(6): 904–913.
10. Xue J, Qin Z, Cai H, et al. Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta‑analysis and trial sequential analysis. Oncotarget. 2017; 8(14): 23322–36.
11. Shen PF, Zhu YC, Wei WR, et al. The results of transperineal versus transrectal prostate biopsy: a systematic review and meta‑analysis. Asian J Androl. 2012; 14(2): 310–5.
12. Guo LH, Wu R, Xu HX, et al. Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized and Controlled Trial. Sci Rep. 2015; 5(1): 16089.
13. Marra G, Marquis A, Tappero S, et al. Transperineal Free‑hand mpMRI Fusion‑targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single‑center Prospective Study. Urology. 2020; 140: 122–31.
14. Meyer AR, Mamawala M, Winoker JS, et al. Transperineal Prostate Biopsy Improves the Detection of Clinically Significant Prostate Cancer among Men on Active Surveillance. J Urol. 2020; 101097JU0000000000001523.
15. Mottet N, van den Bergh RCN, Briers E, et al. EAU‑EANM‑ESTRO‑ESUR‑SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021; 79(2): 243–62.
16. Bass EJ, Donaldson IA, Freeman A, et al. Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach. Prostate Cancer Prostatic, DiS. 2017; 20(3): 311–317.
17. Stejskal J, Hanáček V, Adamcová V, Zachoval R. Transperineální biopsie v diagnostice karcinomu prostaty. Ces Urol. 2021; 25(2): 94–105.
18. Ryšánková K, Hanzlíková P, Vrtková A, Albínová T, Jendřejek M, Krhut J. Transperineálně prováděné fúzní US/MRI navigované biopsie prostaty. Ces Urol. 2021; 25(1): 27-34.
19. Iremashvili VV, Chepurov AK, Kobaladze KM, Gamidov SI. Periprostatic Local Anesthesia With Pudendal Block for Transperineal Ultrasound‑guided Prostate Biopsy: A Randomized Trial. Urology. 2010; 75(5): 1023–7.
20. Ashley RA, Inman BA, Routh JC, et al. Preventing pain during office biopsy of the prostate: A single center, prospective, double‑blind, 3-arm, parallel group, randomized clinical trial. Cancer. 2007; 110(8): 1708–14.
21. Addla SK, Adeyoju AB, Wemyss‑Holden GD, Neilson D. Local anaesthetic for transrectal ultrasound‑guided prostate biopsy: a prospective, randomized, double blind, placebo‑controlled study. Eur Urol. 2003; 43(5): 441–3.
22. Lopez JF, Campbell A, Omer A, et al. Local Anaesthetic Transperineal Prostate (LATP) biopsy using a probe‑mounted transperineal access system: A multi‑centre prospective outcome analysis. BJU Int. 2021; 128(3): 311–318.
23. Catananti C, Gambassi G. Pain assessment in the elderly. Surg Oncol. 2010; 19(3): 140–8.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2022 Issue 3
Most read in this issue
- Nekrolog prof. MUDr. Ondřej Hes, Ph.D.
- Evaluation of pain of transperineal prostate biopsy under local anaesthesia
- Intravesical, radiofrequency-induced chemohyperthermia in the treatment of non-muscle invasive bladder cancer
- Current overview of the role of immunotherapy in onco‑urology