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

Abstract

Abstract Background: Prostate cancer (PCa) diagnosis relies on biopsy procedures, and the transrectal ultrasound biopsy remains widely used. However, fusion biopsy shows promise in improving 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 MRI/US fusion biopsy (STB+FB) and standard TRUS-guided biopsy (STB). Materials and Methods: This IRB approved prospective trial, includes adult men undergoing prostate biopsy. Patients received identical peri-procedural care, including application of lidocaine jelly (2%) into the rectum and subsequent 1% lidocaine injections (10cc per side) into the prostate-seminal vesicle junction and prostatic apical areas bilaterally and the biopsy technique was chosen based on clinical indication and imaging findings. Patient anxiety levels were assessed using the validated STAI questionnaire, and post-biopsy pain using a numerical rating scale. Results: A total of 165 patients were included, with 99 undergoing STB and 66 undergoing STB+FB. There were no significant differences between the groups in terms of age, race, PSA level, prostate volume, and number of prior biopsies. The STB+FB group had a significantly higher number of biopsy cores taken (16.2 vs. 12 cores, p=0.001) and longer procedure time compared to STB (23 vs. 10 minutes, p=0.001). STB biopsy patients were found to experience lower post-procedural anxiety compared to STB+FB, a mean difference of -7 (p=0.001) and 89% of STB+FB group patients experienced severe post-procedural anxiety compared to 59% STB, p=0.002. No difference in pain (p=0.7) was found between the cohorts. The number of prior biopsies was associated with the severe post-procedural anxiety in the STB+FB group (p=0.04). Conclusion: MRI-targeted fusion plus systematic biopsy is associated with higher post-procedural anxiety compared to standard TRUS biopsy and patients with a prior history of repeat biopsies are more prone to experiencing severe anxiety.