Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy.
Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China.
J Urol. 2020 Dec;204(6):1209-1215. doi: 10.1097/JU.0000000000001234. Epub 2020 Jul 6.
Several transperineal biopsy series have proven feasibility under local anesthesia. However, there is a lack of large analyses detailing pain outcomes and factors influencing pain.
From 2016 to 2019 we performed a multicenter prospective study in men undergoing multiparametric magnetic resonance imaging-transperineal fusion biopsies (target+systematic cores) under local anesthesia. Primary outcomes were 1) pain scores (assessed through a 0 to 10-point numeric rating scale) and 2) identification of factors associated with severe pain. The secondary outcome was to evaluate pain influence on clinically significant prostate cancer target cores detection.
We included 1,008 men undergoing transperineal fusion biopsies under local anesthesia. Mean±SD numeric rating scale pain scores were 3.9±2.1 at local anesthesia administration and 3.1±2.3 when performing biopsies. Pain was not associated with lower clinically significant prostate cancer detection on targeted cores (p=0.23 and p=0.47 depending on clinically significant prostate cancer definition). On multivariate analysis age (OR 0.96, 95% CI 0.94-0.99) and severe anxiety (OR 2.99, 95% CI 1.83-4.89) were a protective and risk factor, respectively, for severe biopsy pain. Procedural time was also associated with an increased risk of experiencing severe biopsy pain (OR 1.04, 95% CI 1.00-1.08). If aiming to test the possible effects of anxiety preventive measures on pain, an anxiety cutoff greater than 6 on a numeric rating scale would decrease to 13% the number of patients being treated while identifying 56% of those experiencing severe pain.
Transperineal fusion biopsies under local anesthesia result in moderate pain. Pain does not influence clinically significant prostate cancer target detection. Patient anxiety predicts pain. A numeric rating scale based anxiety assessment may be used to identify those at higher risk for experiencing severe pain in men undergoing transperineal fusion biopsies.
多项经会阴活检系列研究已经证明在局部麻醉下具有可行性。然而，缺乏详细描述疼痛结果和影响疼痛因素的大型分析。
2016 年至 2019 年，我们在接受多参数磁共振成像-经会阴融合活检（靶向+系统核心）的男性中进行了一项多中心前瞻性研究，这些男性均接受局部麻醉。主要结果是 1）疼痛评分（通过 0 到 10 分的数字评分量表评估）和 2）确定与严重疼痛相关的因素。次要结果是评估疼痛对临床上有意义的前列腺癌靶向核心检测的影响。
我们纳入了 1008 例接受局部麻醉下经会阴融合活检的男性。局部麻醉时的平均数字评分量表疼痛评分为 3.9±2.1，活检时为 3.1±2.3。疼痛与靶向核心检测到的临床上有意义的前列腺癌之间无相关性（根据临床上有意义的前列腺癌定义，p=0.23 和 p=0.47）。多变量分析显示，年龄（OR 0.96，95%CI 0.94-0.99）和严重焦虑（OR 2.99，95%CI 1.83-4.89）分别是保护性和风险因素，与严重活检疼痛相关。手术时间也与严重活检疼痛的风险增加相关（OR 1.04，95%CI 1.00-1.08）。如果旨在测试焦虑预防措施对疼痛的可能影响，数字评分量表上的焦虑评分大于 6 将使接受治疗的患者数量减少 13%，同时识别出 56%的严重疼痛患者。
局部麻醉下经会阴融合活检引起中度疼痛。疼痛不会影响临床上有意义的前列腺癌靶向检测。患者焦虑可预测疼痛。基于数字评分量表的焦虑评估可用于识别在接受经会阴融合活检的男性中经历严重疼痛的高风险患者。
