Sonmez Gokhan, Tombul Sevket T, Demirtas Turev, Demirtas Abdullah
Erciyes University, Department of Urology, Kayseri, Turkey.
Erciyes University, Department of Medical History and Ethics, Kayseri, Turkey.
Prostate Int. 2020 Dec;8(4):185-189. doi: 10.1016/j.prnil.2020.05.004. Epub 2020 May 29.
Multiparametric prostate magnetic resonance imaging (mpMRI)-guided fusion prostate biopsy is an emerging technique in the diagnosis of prostate cancer and provides extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. We aimed to investigate the clinical and anatomical risk factors aggravating the pain experienced by patients undergoing mpMRI-guided fusion prostate biopsy.
The prospective study included 319 patients aged 45-75 years who had a prostate-specific antigen <10 ng/ml and a Prostate Imaging Reporting and Data System ≥3 lesion and underwent combined biopsy (targeted biopsy + 12-core standard prostate biopsy) under local anesthesia (intrarectal lidocaine gel + periprostatic nerve block). Immediately after the biopsy procedure, pain assessment was achieved using Visual Analog Scale (VAS). The relationship between the VAS and 13 clinical parameters was evaluated using ordinal logistic regression analysis.
The 319 patients had a mean age of 62.39 ± 6.98 years and a median prostate-specific antigen level of 7.20 (range, 5.20-8.50) ng/ml. The VAS was found to be correlated with 4 of 13 parameters, including (i) a shorter prostate-anus surface distance (cutoff value, 55.5 mm), (ii) a narrower anorectal angle (cutoff value, 106.5°), (iii) a larger total prostate volume (cutoff, 61.6 mm), and (iv) having no history of prior biopsy (biopsy-naive patients).
Anatomical measurements that can be achieved by using mpMRI images (TPV, PASD and ARA) may be useful in the identification of patients at an increased risk of pain during biopsy and also in taking analgesic precautions in such patients.
多参数前列腺磁共振成像（mpMRI）引导下的融合前列腺活检是前列腺癌诊断中的一项新兴技术，可提供有关活检前前列腺、肛门和直肠解剖结构的广泛信息。我们旨在研究加重接受mpMRI引导下融合前列腺活检患者疼痛的临床和解剖学危险因素。
这项前瞻性研究纳入了319例年龄在45 - 75岁之间、前列腺特异性抗原<10 ng/ml且前列腺影像报告和数据系统（PI-RADS）≥3级病变的患者，他们在局部麻醉（直肠内利多卡因凝胶+前列腺周围神经阻滞）下接受联合活检（靶向活检+12针标准前列腺活检）。活检操作结束后，立即使用视觉模拟量表（VAS）进行疼痛评估。使用有序逻辑回归分析评估VAS与13项临床参数之间的关系。
319例患者的平均年龄为62.39±6.98岁，前列腺特异性抗原水平中位数为7.20（范围5.20 - 8.50）ng/ml。发现VAS与13项参数中的4项相关，包括：（i）前列腺-肛门表面距离较短（临界值，55.5 mm）；（ii）直肠肛管角较窄（临界值，106.5°）；（iii）前列腺总体积较大（临界值，61.6 mm）；以及（iv）无既往活检史（初诊患者）。
通过使用mpMRI图像获得的解剖学测量值（TPV、PASD和ARA）可能有助于识别活检期间疼痛风险增加的患者，并有助于对此类患者采取镇痛预防措施。
