Abstract
We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.
Highlights
Prebiopsy prostate magnetic resonance imaging (MRI) is recommended by the National Comprehensive Cancer Network (NCCN) to determine the need for performing prostate biopsy
There were no differences in age, prostate-specific antigen (PSA) level, prostate volume, or history of prostate biopsy between the base periprostatic nerve block (PNB) and base and apex PNB groups
There were no significant differences in visual analog scale (VAS) scores at different time points between the base PNB and base and apex PNB groups
Summary
Prebiopsy prostate magnetic resonance imaging (MRI) is recommended by the National Comprehensive Cancer Network (NCCN) to determine the need for performing prostate biopsy. As the location of the target lesion in FBx is different from that in SBx, pain intensity in SBx should be predicted according to the biopsy site, and the optimal local anaesthesia method for FBx should be used. To our best knowledge, no previous study has analyzed the differences in pain intensity according to the biopsy site, and only a few have assessed the optimal local anaesthesia method for FBx. we investigated pain intensity during various biopsies according to the biopsy site and compared the pain alleviation during various biopsy methods, including MRI cognitive targeted prostate biopsy (CBx), FBx, and SBx, according to the site of PNB. VAS scores Probe insertion Injection at basea Injection at apexb CBxc FBxd SBxe At 15 min post prostate biopsy
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