Presented by: Sriram Deivasigamani MBBS
Duke University Medical Center

Introduction

Prostate cancer diagnosis relies on biopsy procedures, with transrectal ultrasound (TRUS) biopsy remains widely used. However, MRI/US fusion biopsy (FB) shows promise in improving accuracy but the pain and anxiety experienced by patients during biopsies is often overlooked. This study aims to compare pain and anxiety levels between FB and standard TRUS-guided biopsy, addressing a gap in knowledge and improving patient experiences.

Materials

This prospective trial, approved by an institutional review board, included adult men undergoing prostate biopsy. Patients received identical peri-procedural care, and the biopsy technique was chosen based on clinical indication and imaging findings. Standard analgesia was administered to both groups. The primary outcome compared patient anxiety levels using the STAI questionnaire, while the secondary outcome assessed post-procedure pain using a numerical rating scale.

Results

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A total of 165 patients were included in the study, with 99 undergoing TRUS biopsy and 66 undergoing FB. There were no significant differences between the groups in terms of age, race, PSA level, prostate volume, number of prior biopsies, and previous anxiety and pain medications. The FB group had a significantly higher number of biopsy cores and longer procedure time compared to TRUS biopsy (16.2 vs. 12 cores, p=0.001) and (23 vs. 10 minutes, p=0.001). The TRUS biopsy patients were found to experience lower post-procedural anxiety compared to FB, a mean difference of -7 (95% CI, -9, -4.5, p=0.001) and 89% of FB group patients experienced severe anxiety compared to 59% STB, p=0.002. No difference in pain (p=0.7) was found between the cohorts and most of them (STB vs FB) reported experiencing mild pain (53% vs 73%, p=0.1). The number of prior biopsies was associated with the severity of post-procedural anxiety in the FB group (p=0.04). There was a positive correlation between pre-procedural and post-procedural anxiety levels, but no significant correlation between post-procedural anxiety and pain levels.

Conclusion

Fusion biopsy is associated with higher post-procedural anxiety compared to standard TRUS biopsy. Patients with a history of repeat biopsies are more prone to experiencing severe anxiety. Counselling can play a crucial role in reducing patient discomfort, alleviating anxiety, and enhancing compliance with recommended procedures, especially with the growing acceptance of active surveillance in prostate cancer management.

Funding

None

Lead Authors

Eric S. Adams,
Duke University Medical Center

Co-Authors

Srinath Kotamarti, MD
Duke University Medical Center

Mahdi Mottaghi, MD
Duke University MEDICAL Center

Thomas J. Polascik, MD
Duke University Medical Center