Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

  • Nazir, Babar (Department of Oncologic Imaging, National Cancer Centre)
  • Received : 2013.12.06
  • Accepted : 2014.06.01
  • Published : 2014.09.01
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Abstract

Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.

Keywords

References

  1. Sakr WA, Grignon DJ, Crissman JD, Heilbrun LK, Cassin BJ, Pontes JJ, et al. High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic adenocarcinoma between the ages of 20-69: an autopsy study of 249 cases. In Vivo 1994;8:439-443
  2. Ramey JR, Halpern EJ, Gomella LG. Ultrasonography and Biopsy of the prostate. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology, 9th ed. Philadelphia: Saunders, 2007:2883-2895
  3. Autorino R, De Sio M, Di Lorenzo G, Damiano R, Perdona S, Cindolo L, et al. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 2005;174:2091-2097 https://doi.org/10.1097/01.ju.0000181212.51025.06
  4. Torp-Pedersen S, Lee F, Littrup PJ, Siders DB, Kumasaka GH, Solomon MH, et al. Transrectal biopsy of the prostate guided with transrectal US: longitudinal and multiplanar scanning. Radiology 1989;170(1 Pt 1):23-27 https://doi.org/10.1148/radiology.170.1.2642344
  5. Raja J, Ramachandran N, Munneke G, Patel U. Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer. Clin Radiol 2006;61:142-153 https://doi.org/10.1016/j.crad.2005.10.002
  6. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989;142:71-74; discussion 74-75
  7. Norberg M, Egevad L, Holmberg L, Sparen P, Norlen BJ, Busch C. The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 1997;50:562-566 https://doi.org/10.1016/S0090-4295(97)00306-3
  8. Levine MA, Ittman M, Melamed J, Lepor H. Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol 1998;159:471-475; discussion 475-476 https://doi.org/10.1016/S0022-5347(01)63951-X
  9. Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR. Incidence and clinical significance of false-negative sextant prostate biopsies. J Urol 1998;159:1247- 1250 https://doi.org/10.1016/S0022-5347(01)63574-2
  10. Stricker HJ, Ruddock LJ, Wan J, Belville WD. Detection of non-palpable prostate cancer. A mathematical and laboratory model. Br J Urol 1993;71:43-46 https://doi.org/10.1111/j.1464-410X.1993.tb15878.x
  11. Presti JC Jr, O'Dowd GJ, Miller MC, Mattu R, Veltri RW. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 2003;169:125-129
  12. Presti JC Jr, Chang JJ, Bhargava V, Shinohara K. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 2000;163:163-166; discussion 166-167 https://doi.org/10.1016/S0022-5347(05)67995-5
  13. Naughton CK, Smith DS, Humphrey PA, Catalona WJ, Keetch DW. Clinical and pathologic tumor characteristics of prostate cancer as a function of the number of biopsy cores: a retrospective study. Urology 1998;52:808-813 https://doi.org/10.1016/S0090-4295(98)00344-6
  14. Karakiewicz PI, Bazinet M, Aprikian AG, Trudel C, Aronson S, Nachabe M, et al. Outcome of sextant biopsy according to gland volume. Urology 1997;49:55-59 https://doi.org/10.1016/S0090-4295(96)00360-3
  15. Uzzo RG, Wei JT, Waldbaum RS, Perlmutter AP, Byrne JC, Vaughan ED Jr. The influence of prostate size on cancer detection. Urology 1995;46:831-836 https://doi.org/10.1016/S0090-4295(99)80353-7
  16. Scattoni V, Zlotta AR, Nava L, Roscigno M, Montorsi F, Rigatti P. Prostatic transrectal ultrasound (TRUS) guided biopsy schemes and TRUS prostatic lesion-guided biopsies. Eur Urol 2002;(Suppl 1):28-34
  17. Stewart CS, Leibovich BC, Weaver AL, Lieber MM. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol 2001;166:86-91; discussion 91-92 https://doi.org/10.1016/S0022-5347(05)66083-1
  18. Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, et al. A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol 2000;164:397-399 https://doi.org/10.1016/S0022-5347(05)67369-7
  19. Moinzadeh A, Mourtzinos A, Triaca V, Hamawy KJ. A randomized double-blind prospective study evaluating patient tolerance of transrectal ultrasound-guided biopsy of the prostate using prebiopsy rofecoxib. Urology 2003;62:1054-1057 https://doi.org/10.1016/S0090-4295(03)00788-X
  20. Awsare NS, Green JA, Aldwinckle B, Hanbury DC, Boustead GB, McNicholas TA. The use of propofol sedation for transrectal ultrasonography-guided prostate biopsy is associated with high patient satisfaction and acceptability. Eur J Radiol 2007;63:94-95 https://doi.org/10.1016/j.ejrad.2006.12.010
  21. Masood J, Shah N, Lane T, Andrews H, Simpson P, Barua JM. Nitrous oxide (Entonox) inhalation and tolerance of transrectal ultrasound guided prostate biopsy: a double-blind randomized controlled study. J Urol 2002;168:116-120; discussion 120 https://doi.org/10.1016/S0022-5347(05)64842-2
  22. Sur RL, Borboroglu PG, Roberts JL, Amling CL. A prospective randomized comparison of extensive prostate biopsy to standard biopsy with assessment of diagnostic yield, biopsy pain and morbidity. Prostate Cancer Prostatic Dis 2004;7:126-131 https://doi.org/10.1038/sj.pcan.4500713
  23. Luscombe CJ, Cooke PW. Pain during prostate biopsy. Lancet 2004;363:1840-1841 https://doi.org/10.1016/S0140-6736(04)16392-7
  24. Rochester MA, LE Monnier K, Brewster SF. A double-blind, randomized, controlled trial of topical glyceryl trinitrate for transrectal ultrasound guided prostate biopsy. J Urol 2005;173:418-420 https://doi.org/10.1097/01.ju.0000149872.35473.cb
  25. Haq A, Patel HR, Habib MR, Donaldson PJ, Parry JR. Diclofenac suppository analgesia for transrectal ultrasound guided biopsies of the prostate: a double-blind, randomized controlled trial. J Urol 2004;171:1489-1491 https://doi.org/10.1097/01.ju.0000115706.19605.e4
  26. Chang SS, Alberts G, Wells N, Smith JA Jr, Cookson MS. Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol 2001;166:2178-2180 https://doi.org/10.1016/S0022-5347(05)65529-2
  27. Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol 1996;155:607-609 https://doi.org/10.1016/S0022-5347(01)66464-4
  28. Crundwell MC, Cooke PW, Wallace DM. Patients' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases. BJU Int 1999;83:792-795
  29. Naughton CK, Miller DC, Yan Y. Impact of transrectal ultrasound guided prostate biopsy on quality of life: a prospective randomized trial comparing 6 versus 12 cores. J Urol 2001;165:100-103 https://doi.org/10.1097/00005392-200101000-00025
  30. Kaver I, Mabjeesh NJ, Matzkin H. Randomized prospective study of periprostatic local anesthesia during transrectal ultrasound-guided prostate biopsy. Urology 2002;59:405-408 https://doi.org/10.1016/S0090-4295(01)01538-2
  31. Clements R. Ultrasound-guided prostate biopsy in 2005. Clin Radiol 2006;61:140-141 https://doi.org/10.1016/j.crad.2005.08.018
  32. Collins GN, Lloyd SN, Hehir M, McKelvie GB. Multiple transrectal ultrasound-guided prostatic biopsies--true morbidity and patient acceptance. Br J Urol 1993;71:460-463 https://doi.org/10.1111/j.1464-410X.1993.tb15993.x
  33. Seymour H, Perry MJ, Lee-Elliot C, Dundas D, Patel U. Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia. BJU Int 2001;88:540-544
  34. Irani J, Fournier F, Bon D, Gremmo E, Dore B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol 1997;79:608-610 https://doi.org/10.1046/j.1464-410X.1997.00120.x
  35. Bastide C, Lechevallier E, Eghazarian C, Ortega JC, Coulange C. Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors. Prostate Cancer Prostatic Dis 2003;6:239-241 https://doi.org/10.1038/sj.pcan.4500664
  36. Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol 2001;165:445-454 https://doi.org/10.1097/00005392-200102000-00023
  37. Leibovici D, Zisman A, Siegel YI, Sella A, Kleinmann J, Lindner A. Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol 2002;167(2 Pt 1):563-565 https://doi.org/10.1016/S0022-5347(01)69086-4
  38. Han KS, Lee KH; Korean Urologic Oncology Society Prostate Cancer Study Group. Factors influencing pain during transrectal ultrasonography-guided prostate biopsy. Prostate Cancer Prostatic Dis 2008;11:139-142 https://doi.org/10.1038/sj.pcan.4501004
  39. Peyromaure M, Ravery V, Messas A, Toublanc M, Boccon-Gibod L, Boccon-Gibod L. Pain and morbidity of an extensive prostate 10-biopsy protocol: a prospective study in 289 patients. J Urol 2002;167:218-221 https://doi.org/10.1016/S0022-5347(05)65416-X
  40. Philip J, McCabe JE, Roy SD, Samsudin A, Campbell IM, Javle P. Site of local anaesthesia in transrectal ultrasonography-guided 12-core prostate biopsy: does it make a difference? BJU Int 2006;97:263-265 https://doi.org/10.1111/j.1464-410X.2006.05957.x
  41. Rodriguez A, Kyriakou G, Leray E, Lobel B, Guille F. Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature. Eur Urol 2003;44:195-200 https://doi.org/10.1016/S0302-2838(03)00188-X
  42. Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis 2007;10:127-136 https://doi.org/10.1038/sj.pcan.4500935
  43. Giannarini G, Autorino R, Valent F, Mogorovich A, Manassero F, De Maria M, et al. Combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: a randomized, controlled trial. J Urol 2009;181:585-591; discussion 591-593
  44. Soloway MS, Obek C. Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol 2000;163:172-173 https://doi.org/10.1016/S0022-5347(05)67997-9
  45. Davis M, Sofer M, Kim SS, Soloway MS. The procedure of transrectal ultrasound guided biopsy of the prostate: a survey of patient preparation and biopsy technique. J Urol 2002;167(2 Pt 1):566-570 https://doi.org/10.1016/S0022-5347(01)69087-6
  46. Patel HR, Lee F, Arya M, Masood S, Palmer JH, Sheriff MK. A national survey of transrectal ultrasound-guided prostatic biopsies: time for a national guideline. Int J Clin Pract 2003;57:773-774
  47. Inal G, Yazici S, Adsan O, Ozturk B, Kosan M, Cetinkaya M. Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: a randomized placebo controlled study. Int J Urol 2004;11:148-151 https://doi.org/10.1111/j.1442-2042.2003.00768.x
  48. Schostak M, Christoph F, Muller M, Heicappell R, Goessl G, Staehler M, et al. Optimizing local anesthesia during 10-core biopsy of the prostate. Urology 2002;60:253-257 https://doi.org/10.1016/S0090-4295(02)01730-2
  49. Tanagho EA, Schmidt RA, de Araujo CG. Urinary striated sphincter: what is its nerve supply? Urology 1982;20:415-417 https://doi.org/10.1016/0090-4295(82)90468-X
  50. Jones JS, Zippe CD. Rectal sensation test helps avoid pain of apical prostate biopsy. J Urol 2003;170(6 Pt 1):2316-2318 https://doi.org/10.1097/01.ju.0000095792.42718.83
  51. Stirling BN, Shockley KF, Carothers GG, Maatman TJ. Pain perception during transrectal ultrasound guided prostate needle biopsy: an objective analysis of local anesthesia use. Prostate Cancer Prostatic Dis 2002;5:209-211 https://doi.org/10.1038/sj.pcan.4500598
  52. Hollabaugh RS Jr, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology 1997;49:426-434 https://doi.org/10.1016/S0090-4295(96)00497-9
  53. Yun TJ, Lee HJ, Kim SH, Lee SE, Cho JY, Seong CK. Does the intrarectal instillation of lidocaine gel before periprostatic neurovascular bundle block during transrectal ultrasound guided prostate biopsies improve analgesic efficacy? A prospective, randomized trial. J Urol 2007;178:103-106 https://doi.org/10.1016/j.juro.2007.03.047
  54. Issa MM, Ritenour C, Greenberger M, Hollabaugh R Jr, Steiner M. The prostate anesthetic block for outpatient prostate surgery. World J Urol 1998;16:378-383 https://doi.org/10.1007/s003450050085
  55. Hong YM, Lai FC, Chon CH, McNeal JE, Presti JC Jr. Impact of prior biopsy scheme on pathologic features of cancers detected on repeat biopsies. Urol Oncol 2004;22:7-10 https://doi.org/10.1016/S1078-1439(03)00147-9
  56. Obek C, Onal B, Ozkan B, Onder AU, Yalcin V, Solok V. Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased infectious or hemorrhagic complications? A prospective randomized trial. J Urol 2002;168:558-561 https://doi.org/10.1016/S0022-5347(05)64679-4
  57. Nguyen CT, Jones JS. Comparison of traditional basal and apical periprostatic block: impact on injection pain and biopsy pain. BJU Int 2007;99:575-578 https://doi.org/10.1111/j.1464-410X.2006.06652.x
  58. Emiliozzi P, Longhi S, Scarpone P, Pansadoro A, DePaula F, Pansadoro V. The value of a single biopsy with 12 transperineal cores for detecting prostate cancer in patients with elevated prostate specific antigen. J Urol 2001;166:845-850 https://doi.org/10.1016/S0022-5347(05)65849-1
  59. Mutaguchi K, Shinohara K, Matsubara A, Yasumoto H, Mita K, Usui T. Local anesthesia during 10 core biopsy of the prostate: comparison of 2 methods. J Urol 2005;173:742-745 https://doi.org/10.1097/01.ju.0000152119.28959.3a
  60. Bingqian L, Peihuan L, Yudong W, Jinxing W, Zhiyong W. Intraprostatic local anesthesia with periprostatic nerve block for transrectal ultrasound guided prostate biopsy. J Urol 2009;182:479-483; discussion 483-484 https://doi.org/10.1016/j.juro.2009.04.029
  61. Stirling BN, Shockley KF, Carothers GG, Maatman TJ. Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology 2002;60:89-92 https://doi.org/10.1016/S0090-4295(02)01671-0
  62. Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL. Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol 2001;166:1343-1345 https://doi.org/10.1016/S0022-5347(05)65765-5
  63. Lynn NN, Collins GN, Brown SC, O'Reilly PH. Periprostatic nerve block gives better analgesia for prostatic biopsy. BJU Int 2002;90:424-426 https://doi.org/10.1046/j.1464-410X.2002.02902.x
  64. Jones JS, Oder M, Zippe CD. Saturation prostate biopsy with periprostatic block can be performed in office. J Urol 2002;168:2108-2110 https://doi.org/10.1016/S0022-5347(05)64307-8
  65. Kilciler M, Demir E, Bedir S, Erten K, Kilic C, Peker AF. Pain scores and early complications of transrectal ultrasonography-guided prostate biopsy: effect of patient position. Urol Int 2007;79:361-363 https://doi.org/10.1159/000109724
  66. Rabets JC, Jones JS, Patel AR, Zippe CD. Bupivacaine provides rapid, effective periprostatic anaesthesia for transrectal prostate biopsy. BJU Int 2004;93:1216-1217 https://doi.org/10.1111/j.1464-410X.2004.04843.x
  67. Ozden E, Yaman O, Gogus C, Ozgencil E, Soygur T. The optimum doses of and injection locations for periprostatic nerve blockade for transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, placebo controlled study. J Urol 2003;170(6 Pt 1):2319-2322 https://doi.org/10.1097/01.ju.0000095760.29931.f7
  68. Lee-Elliott CE, Dundas D, Patel U. Randomized trial of lidocaine vs lidocaine/bupivacaine periprostatic injection on longitudinal pain scores after prostate biopsy. J Urol 2004;171:247-250 https://doi.org/10.1097/01.ju.0000098688.12631.a0
  69. Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A. Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 2004;22:281-284 https://doi.org/10.1007/s00345-003-0386-4
  70. Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol 1998;160(6 Pt 1):2115-2120 https://doi.org/10.1016/S0022-5347(01)62255-9
  71. Addla SK, Adeyoju AA, Wemyss-Holden GD, Neilson D. Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study. Eur Urol 2003;43:441-443 https://doi.org/10.1016/S0302-2838(03)00104-0
  72. Richman JM, Carter HB, Hanna MN, Murphy JD, Rowlingson AJ, Andrews RA, et al. Efficacy of periprostatic local anesthetic for prostate biopsy analgesia: a meta-analysis. Urology 2006;67:1224-1228 https://doi.org/10.1016/j.urology.2005.12.030
  73. Cevik I, Ozveri H, Dillioglugil O, Akdas A. Lack of effect of intrarectal lidocaine for pain control during transrectal prostate biopsy: a randomized prospective study. Eur Urol 2002;42:217-220 https://doi.org/10.1016/S0302-2838(02)00275-0
  74. Song SH, Kim JK, Song K, Ahn H, Kim CS. Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Int J Urol 2006;13:707-710 https://doi.org/10.1111/j.1442-2042.2006.01390.x
  75. Ghani KR, Dundas D, Patel U. Bleeding after transrectal ultrasonography-guided prostate biopsy: a study of 7-day morbidity after a six-, eight- and 12-core biopsy protocol. BJU Int 2004;94:1014-1020 https://doi.org/10.1111/j.1464-410X.2004.05096.x
  76. Turgut AT, Olcucuoglu E, Kosar P, Geyik PO, Kosar U. Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsy. J Clin Ultrasound 2008;36:67-71 https://doi.org/10.1002/jcu.20424
  77. Taverna G, Maffezzini M, Benetti A, Seveso M, Giusti G, Graziotti P. A single injection of lidocaine as local anesthesia for ultrasound guided needle biopsy of the prostate. J Urol 2002;167:222-223 https://doi.org/10.1016/S0022-5347(05)65417-1
  78. Vaidya A, Soloway MS. Periprostatic local anesthesia before ultrasound-guided prostate biopsy: an update of the miami experience. Eur Urol 2001;40:135-138 https://doi.org/10.1159/000049763
  79. Matlaga BR, Eskew LA, McCullough DL. Prostate biopsy: indications and technique. J Urol 2003;169:12-19 https://doi.org/10.1016/S0022-5347(05)64024-4

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