[Prostate biopsy strategies. A review of the literature]

Assessment and clinical factors associated with pain in patients undergoing transrectal prostate biopsy

OBJECTIVES

To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain.

MATERIAL AND METHODS

Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain.

RESULTS

A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure.

CONCLUSIONS

Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure.

Urinary tract symptoms and erectile function in patients at risk of prostate cancer

INTRODUCTION AND OBJECTIVE

We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study.

MATERIAL AND METHOD

1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group.

RESULTS

The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS.

CONCLUSIONS

Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

[Saturation biopsy in prostate cancer diagnosis]

AIMS

To analyze the results obtained after doing saturation prostate biopsy to a series of patients with high level of PSA. SUBJECTS, MATERIAL AND METHOD: Among 2006 and 2007 saturation biopsies have been realized in our Service to 32 patients with high PSA, previous biopsies without diagnosis of prostate cancer and high suspicion of malignant disease.

RESULTS

The mean age was 65.81 years, with an average of previous biopsies of 2.41 (range: 1 to 5). Mean of PSA was 15.45 ng/dl (range: 5.63 to 35.47 ng/ml). The mean number of cores obtained in the saturation biopsies was of 20.78 (range: 16-26). 13 were diagnosed prostate adenocarcinomas (40.63%), of which 10 had previous diagnosis of PIN or atipia. 8 patients underwent radical prostatectomy, 3 cases were treated with radiotherapy, 1 case was treated with hormonetherapy and the remaining one is kept in watchful waiting. Concordance of Gleason grade was in 6 of 8 patients treated surgically.

CONCLUSIONS

Saturation biopsy is an effective method for the diagnosis of prostate cancer after several negative biopsies and a strong clinical suspicion of malignant pathology. Saturation biopsy is not a first choice procedure for the diagnosis of prostate cancer.