Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.
World J Urol. 2022 Sep;40(9):2239-2244. doi: 10.1007/s00345-022-04083-3. Epub 2022 Jul 14.
Multiparametric magnetic resonance imaging fusion targeted prostate biopsy (MR-TB) has emerged to the biopsy technique of choice for evaluation of patients with suspected prostate cancer (PCA). The study aimed to determine expected and experienced pain during MR-TB depending on patients' psychological state.
We prospectively enrolled 108 men with suspicion of PCA who underwent MR-TB. All patients completed self-reported validated questionnaires assessing pain, stress, self-efficacy, anxiety and study-specific questionnaires on expected and experienced pain before, during and after MR-TB. Patient characteristics and survey scores were obtained.
Overall, pain levels during MR-TB were low (mean 2.8/10 ± 2.5 Numerical Rating Scale, NRS). 10/86 (11.6%) participants reported severe pain (≥ 7/10 NRS). Pain correlated significantly with anxiety (r = 0.42), stress (r = 0.22) and pain expectancy (r = 0.58). High self-efficacy did not show increased pain resilience. Participants anticipated more pain than experienced during each step of MR-TB with significant differences concerning local anesthesia and core sampling (both p < 0.001), among others. Expectancy and actual pain did not match regarding severity and impact of the total amount of cores taken (p < 0.05). Independent predictors of increased pain at biopsy were prostate volume > 50 ml (p = 0.0179) and expected pain during rectal manipulation (p < 0.001).
Pain during MR-TB can be positively influenced by reducing men's anxiety, stress and pain expectancy. To meet the needs of the audience, clinicians should address concrete pain levels of each procedural step and consider special treatment for patients with prostate volume > 50 ml and men reporting on increased rectal sensitivity.
多参数磁共振成像融合靶向前列腺活检（MR-TB）已成为评估疑似前列腺癌（PCA）患者的首选活检技术。本研究旨在根据患者的心理状态，确定 MR-TB 期间的预期和实际疼痛。
我们前瞻性地招募了 108 名疑似 PCA 患者，他们接受了 MR-TB。所有患者在 MR-TB 前后完成了自我报告的经过验证的问卷，评估疼痛、压力、自我效能、焦虑和特定于研究的预期和实际疼痛问卷。记录患者特征和调查评分。
总体而言，MR-TB 期间的疼痛水平较低（平均 2.8/10±2.5 数字评分量表，NRS）。10/86（11.6%）名参与者报告了严重疼痛（≥7/10 NRS）。疼痛与焦虑（r=0.42）、压力（r=0.22）和疼痛预期（r=0.58）显著相关。高自我效能感并没有增加疼痛的恢复能力。参与者在 MR-TB 的每个步骤中预期的疼痛都比实际经历的疼痛更严重，局部麻醉和核心取样的差异具有统计学意义（均 p<0.001）等。关于总取核数的严重程度和影响，预期和实际疼痛不匹配（p<0.05）。活检时疼痛增加的独立预测因素是前列腺体积>50ml（p=0.0179）和直肠操作期间的预期疼痛（p<0.001）。
通过降低男性的焦虑、压力和疼痛预期，可以积极影响 MR-TB 期间的疼痛。为了满足受众的需求，临床医生应针对每个操作步骤的具体疼痛水平，并考虑对前列腺体积>50ml 的患者和报告直肠敏感性增加的患者进行特殊治疗。
