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

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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 ( IF 5.1 ) Pub Date : 2023-11-25 , DOI: 10.1038/s41391-023-00760-5
Sriram Deivasigamani ₁ , Eric S Adams ₁ , Srinath Kotamarti ₁ , Mahdi Mottaghi ₂ , Terek Taha _{1,

3} , Ali Aminsharifi _{1,

4} , Zoe Michael _{1,

2} , Denis Seguier ₅ , Thomas J Polascik _{1,

2}

Affiliation

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.

中文翻译：

传统经直肠超声前列腺活检与磁共振成像-超声融合引导活检相关的手术焦虑和疼痛的比较：一项前瞻性队列试验

背景

前列腺癌 (PCa) 的诊断依赖于活检，其中经直肠超声 (TRUS) 活检很常见。融合活检 (FB) 提高了诊断准确性，但患者在活检过程中经历的疼痛和焦虑常常被忽视。本研究旨在比较标准 TRUS 引导活检 (STB) 和系统加 MRI/US 融合活检 (STB + FB) 之间的疼痛和焦虑水平。

材料和方法

该研究涉及接受活组织检查的成年男性，接受相同的围手术期护理，包括在直肠中注射 2% 利多卡因胶冻，随后在前列腺-精囊交界处和双侧前列腺顶端区域注射 1% 利多卡因（每侧 10cc）。根据临床和影像学结果选择活检技术。使用状态-特质焦虑量表（STAI）问卷评估活检前和术后的焦虑水平，分为轻度（20-37）、中度（38-44）或重度（45-80）。活检后疼痛采用数字评分表进行评估，范围从 0 到 10。

结果

在 165 名患者中，99 名接受了 STB，66 名接受了 STB + FB。各组之间在年龄、种族、前列腺特异性抗原、前列腺体积或既往活检中没有观察到显着差异。 STB + FB 组采集了更多的活检核心（16.2 vs. 12， p = 0.001）并且手术时间更长（23 vs. 10 分钟， p = 0.001）。与 STB + FB 相比，STB 活检患者的术后焦虑程度较低，平均差异为 -7（ p = 0.001，d = 0.92）。在 STB + FB 组中，89% 的人经历了严重的术后焦虑，而 STB 组中这一比例为 59% ( p = 0.002)。术后疼痛没有显着差异（ p = 0.7）。在 STB + FB 组中，既往进行过活检的患者 STAI(S) 焦虑评分显着较高 ( p = 0.005)，且既往活检次数与焦虑严重程度相关 ( p = 0.04)。