Patient-reported pain, discomfort, and anxiety during magnetic resonance imaging-targeted prostate biopsy

  • Gregory T. Chesnut Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center
  • Piotr Zareba Department of Surgery, Urology Division, McMaster University
  • Daniel D. Sjoberg
  • Maha Mamoor Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center
  • Sigrid Carlsson Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center; Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
  • Taehyoung Lee Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center
  • Jonathan Fainberg Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center
  • Emily Vertosick Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
  • Michael Manasia Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center
  • Mary Schoen Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center
  • Behfar Ehdaie Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
Keywords: Prostatic Neoplasms, Magnetic Resonance Imaging, Image-Guided Biopsy, Anxiety, Pain Measurement

Abstract

Introduction: The addition of targeted prostate biopsy to systemic biopsy impacts patient experience. We examined patient-reported pain, discomfort, anxiety, and tolerability among men undergoing magnetic resonance imaging (MRI)-targeted prostate biopsy in addition to transrectal ultrasound-guided systematic biopsy compared to those undergoing systematic biopsy alone.

Methods: All patients underwent transrectal systematic 14-core biopsies. Patients with regions of interest on MRI underwent additional targeted biopsies. All patients received equivalent periprostatic nerve block. Four single-item, standard 11-point numerical rating scales evaluating pain, discomfort, anxiety, and tolerability were completed immediately after biopsy. Differences in means were compared using t-tests. Correlation between rated domains was tested using Spearman’s correlation coefficient.  

Results: Of 273 consecutive patients, 195 (71%) underwent targeted biopsy and 188 (69%) had undergone prior biopsy. In all men, the median score for pain and tolerability was 3, while the median score for discomfort and anxiety was 4. Pain was rated at 7 or above by 15% of patients. Moderate correlation between pain, discomfort, anxiety, and tolerability of repeat biopsy was observed (Spearman’s p between 0.48 and 0.76). Compared to patients undergoing systematic biopsy alone, men who received both targeted and systematic biopsies reported higher anxiety scores (difference 1.2; 95% confidence interval [CI] 0.4–2.0; p=0.004) and discomfort (difference 1.0; 95% CI 0.3–1.7; p<0.001).

Conclusions: Patients undergoing targeted and systematic biopsies report more discomfort and anxiety than patients undergoing systematic biopsies alone. Absolute differences are small, and patients are willing to undergo repeat biopsy if advised. Interventions to reduce biopsy-related anxiety are needed.

Published
2019-07-15
How to Cite
Chesnut, G. T., Zareba, P., Sjoberg, D. D., Mamoor, M., Carlsson, S., Lee, T., Fainberg, J., Vertosick, E., Manasia, M., Schoen, M., & Ehdaie, B. (2019). Patient-reported pain, discomfort, and anxiety during magnetic resonance imaging-targeted prostate biopsy. Canadian Urological Association Journal, 14(5). https://doi.org/10.5489/cuaj.6102
Section
Original Research