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Deivasigamani S, Adams ES, Kotamarti S, Mottaghi M, Taha T, Aminsharifi A, Michael Z, Seguier D, Polascik TJ. 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. Prostate Cancer Prostatic Dis 2024; 27:294-299. [PMID: 38001362 DOI: 10.1038/s41391-023-00760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Prostate cancer (PCa) diagnosis relies on biopsies, with transrectal ultrasound (TRUS) biopsies being common. Fusion biopsy (FB) offers improved 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 standard TRUS-guided biopsy (STB) and systematic plus MRI/US fusion biopsy (STB + FB). MATERIALS AND METHODS The study involved adult men undergoing biopsies, receiving identical peri-procedural care, including 2% lidocaine jelly in the rectum and subsequent 1% lidocaine injections (10cc per side) into the prostate-seminal vesicle junction and prostatic apical areas bilaterally. The biopsy technique was chosen based on clinical and imaging findings. Pre- and post-biopsy anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire, categorized as mild (20-37), moderate (38-44), or severe (45-80). Post-biopsy pain was evaluated on a numerical rating scale, ranging from 0 to 10. RESULTS Of the 165 patients, 99 underwent STB, and 66 underwent STB + FB. No significant differences were observed in age, race, prostate-specific antigen, prostate volume, or prior biopsies between the groups. The STB + FB group had more biopsy cores taken (16.2 vs. 12, p = 0.001) and a longer procedure time (23 vs. 10 min, p = 0.001). STB biopsy patients experienced lower post-procedural anxiety compared to STB + FB, with a mean difference of -7 (p = 0.001, d = 0.92). In the STB + FB group, 89% experienced severe post-procedural anxiety compared to 59% in STB (p = 0.002). There was no significant difference in post-procedural pain (p = 0.7). Patients with prior biopsies had significantly higher STAI(S) anxiety scores (p = 0.005), and the number of prior biopsies correlated with anxiety severity (p = 0.04) in STB + FB group. CONCLUSION In summary, STB + FB group demonstrated higher post-procedural anxiety levels than the STB group, with no difference in pain levels. Additionally, patients with a history of repeat biopsies were more likely to exhibit higher STAI(S) anxiety scores.
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Affiliation(s)
| | - Eric S Adams
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Srinath Kotamarti
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mahdi Mottaghi
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
| | - Terek Taha
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Ziv Medical Center, Safed, Israel
| | - Ali Aminsharifi
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Zoe Michael
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
| | - Denis Seguier
- Department of Urology, Lille University, Lille, France
| | - Thomas J Polascik
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
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Vanoli S, Grobet-Jeandin E, Windisch O, Valerio M, Benamran D. Evolution of anxiety management in prostate biopsy under local anesthesia: a narrative review. World J Urol 2024; 42:43. [PMID: 38244150 PMCID: PMC10799769 DOI: 10.1007/s00345-023-04723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/24/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND METHODS Prostate biopsy (PB) is an essential step in the diagnosis and active surveillance of prostate cancer (PCa). Transperineal PB (TP-PB) is now the recommended approach and is mostly conducted under local anesthesia. However, this procedure can potentially cause anxiety for patients, given the oncological context and the fear of peri-procedural pain and complications. The objective of this narrative review is to summarize the currently available tools for the management of peri-interventional anxiety during TP-PB, with a particular emphasis on the potential role of virtual reality (VR) in this setting. RESULTS In TP-PB, preoperative anxiety can lead to increased pain perception, longer procedure time, and decreased patient satisfaction. Pharmacological and non-pharmacological approaches have been explored to reduce anxiety, such as premedication, deep sedation, education, relaxation techniques, hypnosis, and music therapy, albeit with mixed results. VR has recently emerged in the technological armamentarium for managing pain and anxiety, and the efficiency of this technology has been evaluated in various medical fields, including pediatrics, gastroenterology, urology, gynecology, and psychiatry. CONCLUSION Despite the paucity of available data, VR appears to be a safe and effective technique in reducing anxiety in many procedures, even in frail patients. No studies have evaluated the role of VR in TP-PB. Future research should thus explore the optimal way to implement VR technology and any potential benefits for TP-PB patients.
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Affiliation(s)
- Sylvain Vanoli
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Elisabeth Grobet-Jeandin
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Olivier Windisch
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Massimo Valerio
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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Krausewitz P, Bundschuh RA, Gaertner FC, Essler M, Attenberger U, Luetkens J, Kristiansen G, Muders M, Ohlmann CH, Hauser S, Ellinger J, Ritter M. DEPROMP Trial: the additive value of PSMA-PET/CT-guided biopsy for prostate cancer management in biopsy naïve men-study protocol for a randomized trial. Trials 2023; 24:167. [PMID: 36879271 PMCID: PMC9987083 DOI: 10.1186/s13063-023-07197-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The primary objective is to determine the proportion of men with suspected prostate cancer (PCA) in whom the management plans are changed by additive gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) guided prostate biopsy (PET-TB) in combination with standard of care (SOC) using systematic (SB) and multiparametric magnetic resonance imaging-guided biopsy (MR-TB) compared with SOC alone. The major secondary objectives are to determine the additive value of the combined approach of SB + MR-TB + PET-TB (PET/MR-TB) for detecting clinically significant PCA (csPCA) compared to SOC; to determine sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of imaging techniques, respective imaging classification systems, and each biopsy method; and to compare preoperatively defined tumor burden and biomarker expression and pathological tumor extent in prostate specimens. METHODS The DEPROMP study is a prospective, open-label, interventional investigator-initiated trial. Risk stratification and management plans after PET/MR-TB are conducted randomized and blinded by different evaluation teams of experienced urologists based on histopathological analysis and imaging information: one including all results of the PET/MR-TB and one excluding the additional information gained by PSMA-PET/CT guided biopsy. The power calculation was centered on pilot data, and we will recruit up to 230 biopsy-naïve men who will undergo PET/MR-TB for suspected PCA. Conduct and reporting of MRI and PSMA-PET/CT will be performed in a blinded fashion. DISCUSSION The DEPROMP Trial will be the first to evaluate the clinically relevant effects of the use of PSMA-PET/CT in patients with suspected PCA compared to current SOC. The study will provide prospective data to determine the diagnostic yields of additional PET-TB in men with suspected PCA and the impact on treatment plans in terms of intra- and intermodal changes. The results will allow a comparative analysis of risk stratification by each biopsy method, including a performance analysis of the corresponding rating systems. This will reveal potential intermethod and pre- and postoperative discordances of tumor stage and grading, providing the opportunity to critically assess the need for multiple biopsies. TRIAL REGISTRATION German Clinical Study Register DRKS 00024134. Registered on 26 January 2021.
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Affiliation(s)
- P Krausewitz
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany.
| | - R A Bundschuh
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - F C Gaertner
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - M Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - U Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - J Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - G Kristiansen
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - M Muders
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - C-H Ohlmann
- Department of Urology, Johanniter Hospital Bonn, Bonn, Germany
| | - S Hauser
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - J Ellinger
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - M Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
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Sonmez G, Demirtas A. Prospective analysis of pain expectancy and experience during MR-fusion prostate biopsy: does reality match patients' expectancy? World J Urol 2023; 41:285-286. [PMID: 36481805 DOI: 10.1007/s00345-022-04241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Gokhan Sonmez
- Division of Urooncology, Department of Urology, Erciyes University, Kosk Mah. Erciyes Üniversitesi, Üroloji Poliklinikleri, PK: 38039, Melikgazi, Kayseri, Turkey.
| | - Abdullah Demirtas
- Division of Urooncology, Department of Urology, Erciyes University, Kosk Mah. Erciyes Üniversitesi, Üroloji Poliklinikleri, PK: 38039, Melikgazi, Kayseri, Turkey.
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Krausewitz P, Fostitsch D, Weiten R, Kluemper N, Stein J, Luetkens J, Kristiansen G, Ellinger J, Ritter M. Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study. World J Urol 2023; 41:19-25. [PMID: 36477403 PMCID: PMC9849165 DOI: 10.1007/s00345-022-04230-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution. METHODS Two hundred and fifty-nine men with PI-RADS 3-5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2. RESULTS CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4-5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors. CONCLUSION SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Dorothea Fostitsch
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Richard Weiten
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Niklas Kluemper
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Johannes Stein
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Julian Luetkens
- Department of Diagnostic and Interventional Radiology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Jörg Ellinger
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
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Krausewitz P, Kluemper N, Richter AP, Büttner T, Kristiansen G, Ritter M, Ellinger J. Early Dynamics of Quantitative SEPT9 and SHOX2 Methylation in Circulating Cell-Free Plasma DNA during Prostate Biopsy for Prostate Cancer Diagnosis. Cancers (Basel) 2022; 14:cancers14184355. [PMID: 36139516 PMCID: PMC9496792 DOI: 10.3390/cancers14184355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The methylation status of Septin 9 (SEPT9) and short stature homeobox 2 (SHOX2) in circulating cell-free DNA (ccfDNA) are validated pan-cancer biomarkers. The present proof-of-concept study aimed to investigate the potential and dynamics of quantitative SEPT9 and SHOX2 methylation in prostate cancer (PCa) patient tissue and ccfDNA during prostate biopsy as a diagnostic tool. Methods: The methylation patterns of SEPT9 and SHOX2 in prostate tissue were analyzed using The Cancer Genome Atlas data set (n = 498 PCa and n = 50 normal adjacent prostate tissue (NAT)). Next, dynamic changes of ccfDNA methylation were quantified in prospectively enrolled patients undergoing prostate biopsy (n = 72), local treatment for PCa (n = 7; radical prostatectomy and radiotherapy) as well as systemic treatment for PCa (n = 6; chemotherapy and 177-Lu-PSMA-therapy). Biomarker levels were correlated with clinicopathological parameters. Results: SEPT9 and SHOX2 were hypermethylated in PCa tissue (p < 0.001) and allowed discrimination of PCa and non-tumor prostate tissue (mSEPT9: AUC 0.87, 95%CI [0.82−0.92]; mSHOX2: AUC 0.89, 95%CI 0.84−0.94). SHOX2 methylation and mRNA levels were significantly higher in PCa tissue and increased with tumor stage and grade, as well as in patients suffering from biochemical recurrence following radical prostatectomy. SEPT9 and SHOX2 ccfDNA methylation allowed distinguishing patients with localized and metastatic disease (p < 0.001 for both). In addition, methylation levels increased shortly after prostate biopsy only in patients with PCa (ΔmSEPT9: p < 0.001 and ΔmSHOX2: p = 0.001). Conclusions: The early dynamics of methylated SEPT9 and SHOX2 in ccfDNA allow differentiation between PCa patients and patients without PCa and is a promising marker for tumor monitoring in the metastatic stage to determine tumor burden under systemic therapy.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-15118853551
| | - Niklas Kluemper
- Department of Urology and Pediatric Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ayk-Peter Richter
- Department of Urology and Pediatric Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Thomas Büttner
- Department of Urology and Pediatric Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Jörg Ellinger
- Department of Urology and Pediatric Urology, University Hospital Bonn, 53127 Bonn, Germany
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