Patient Experience of Systematic Versus Fusion Prostate Biopsies

Abstract

BackgroundThe magnetic resonance imaging/ultrasound fusion-guided biopsy (FBx) technique has gained popularity in prostate cancer (PCa) diagnostics, but little is known about its effect on patient experience. ObjectiveTo evaluate pain, discomfort and other non-infectious complications in PCa patients undergoing either systematic 12-core transrectal ultrasound-guided biopsy (SBx) or FBx and patient willingness to undergo rebiopsy. Design, setting, and participantsA prospective trial of 262 male patients, 203 of whom underwent transrectal SBx and 59 FBx at Helsinki University Hospital in 2015–2016. Patients completed two questionnaires immediately after and at 30 d after biopsy. Outcome measurements and statistical analysesPatients reported pain and discomfort on a numeric rating scale (NRS; 0–10) immediately after biopsy. At 30 d, discomfort was measured on a scale ranging from 1 (no inconvenience) to 4 (maximal inconvenience). Other symptoms were reported dichotomously (yes/no) in both questionnaires. Mann-Whitney U, Pearson's χ2, and logistic regression tests were used. Results and limitationsFor the SBx and FBx groups the median number of cores per patient was 12 and three, respectively. At 30 d, a higher proportion of patients in the SBx group had experienced pain than in the FBx group (70/203 [34%] vs 12/59 [20%]; p=0.043), whereas there was no difference in the median discomfort scores. Hematuria was less common in the FBx group (26/59 [44%] vs 140/203 [69%]; p<0.001). Patients willing to undergo rebiopsy immediately post-biopsy reported lower median NRS (3.0 [interquartile range 2.0–5.0] vs 5.0 [4.3–6.0]; p<0.001) and discomfort scores (4.0 [2.0–6.0] vs 7.0 [5.0–8.0]; p<0.001) than those unwilling. At 30 d, less discomfort (2.0 [interquartile range 1.0–2.0] vs 2.0 [2.0–3.0]; p=0.008) and fever (6/195 [3.1%] vs 6/28 [22%]; p=0.001) were experienced by patients willing to undergo rebiopsy. The nonrandomized design was a limitation. ConclusionsFBx is associated with less pain and hematuria than SBx during the 30-d interval after biopsy. Patient summaryMagnetic resonance imaging (MRI)-targeted prostate biopsy is associated with less pain, discomfort, and blood in the urine compared to the standard ultrasound-guided procedure. Performing MRI-targeted procedures may reduce biopsy-related complications and promote adherence to recommended repeat biopsy for patients on active surveillance for prostate cancer.