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Hayne D, Grummet J, Espinoza D, McCombie SP, Chalasani V, Ford KS, Frydenberg M, Gilling P, Gordon B, Hawks C, Konstantatos A, Martin AJ, Nixon A, O'Brien C, Patel MI, Sengupta S, Shahbaz S, Subramaniam S, Williams S, Woo HH, Stockler MR, Davis ID, Buchan N. 'Pain-free TRUS B': a phase 3 double-blind placebo-controlled randomized trial of methoxyflurane with periprostatic local anaesthesia to reduce the discomfort of transrectal ultrasonography-guided prostate biopsy (ANZUP 1501). BJU Int 2021; 129:591-600. [PMID: 34273231 PMCID: PMC9291594 DOI: 10.1111/bju.15552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective To determine whether the addition of inhaled methoxyflurane to periprostatic infiltration of local anaesthetic (PILA) during transrectal ultrasonography‐guided prostate biopsies (TRUSBs) improved pain and other aspects of the experience. Patients and Methods We conducted a multicentre, placebo‐controlled, double‐blind, randomized phase 3 trial, involving 420 men undergoing their first TRUSB. The intervention was PILA plus a patient‐controlled device containing either 3 mL methoxyflurane, or 3 mL 0.9% saline plus one drop of methoxyflurane to preserve blinding. The primary outcome was the pain score (0–10) reported by the participant after 15 min. Secondary outcomes included ratings of other aspects of the biopsy experience, willingness to undergo future biopsies, urologists’ ratings, biopsy completion, and adverse events. Results The mean (SE) pain scores 15 min after TRUSB were 2.51 (0.22) in those assigned methoxyflurane vs 2.82 (0.22) for placebo (difference 0.31, 95% confidence interval [CI] −0.75 to 0.14; P = 0.18). Methoxyflurane was associated with better scores for discomfort (difference −0.48, 95% CI −0.92 to −0.03; P = 0.035, adjusted [adj.] P = 0.076), whole experience (difference −0.50, 95% CI −0.92 to −0.08; P = 0.021, adj. P = 0.053), and willingness to undergo repeat biopsies (odds ratio 1.67, 95% CI 1.12–2.49; P = 0.01) than placebo. Methoxyflurane resulted in higher scores for drowsiness (difference +1.64, 95% CI 1.21–2.07; P < 0.001, adj. P < 0.001) and dizziness (difference +1.78, 95% CI 1.31–2.24; P < 0.001, adj. P < 0.001) than placebo. There was no significant difference in the number of ≥ grade 3 adverse events. Conclusions We found no evidence that methoxyflurane improved pain scores at 15 min, however, improvements were seen in patient‐reported discomfort, overall experience, and willingness to undergo repeat biopsies.
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Affiliation(s)
- Dickon Hayne
- UWA Medical School, University of Western Australia, Perth, WA, Australia.,Fiona Stanley Hospital, Perth, WA, Australia
| | - Jeremy Grummet
- Alfred Health, Central Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | | | - Steve P McCombie
- UWA Medical School, University of Western Australia, Perth, WA, Australia.,Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Kate S Ford
- NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.,Cabrini Institute, Cabrini Health, Melbourne, Vic., Australia
| | | | - Barbara Gordon
- Canterbury Urology Research Trust, Christchurch, New Zealand
| | - Cynthia Hawks
- UWA Medical School, University of Western Australia, Perth, WA, Australia.,Fiona Stanley Hospital, Perth, WA, Australia
| | - Alex Konstantatos
- Alfred Health, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - Andrew J Martin
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | | | - Colin O'Brien
- Consumer Advisory Panel, Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, NSW, Australia
| | - Manish I Patel
- Discipline of Surgery, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Shomik Sengupta
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.,Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia
| | - Shekib Shahbaz
- Monash Health, Casey Hospital, Melbourne, Vic., Australia
| | - Shalini Subramaniam
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Scott Williams
- Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Henry H Woo
- Sydney Adventist Hospital, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Martin R Stockler
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia.,Cancer Services, Eastern Health, Melbourne, Vic., Australia
| | - Nick Buchan
- Canterbury Urology Research Trust, Christchurch, New Zealand
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Moe A, Hayne D. Transrectal ultrasound biopsy of the prostate: does it still have a role in prostate cancer diagnosis? Transl Androl Urol 2020; 9:3018-3024. [PMID: 33457275 PMCID: PMC7807378 DOI: 10.21037/tau.2019.09.37] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Transrectal ultrasound (TRUS) guided biopsy of the prostate has been a standard diagnostic approach for prostate cancer over the past thirty years. Today, the role of TRUS biopsy is being challenged by transperineal (TP) prostate biopsy due to concerns over the safety and diagnostic yield of TRUS biopsy. TRUS biopsy still offers a convenient, reliable and accessible tool for diagnosing prostate cancer in the majority of patients. It continues to play a role in prostate cancer diagnosis, especially where hospital resource allocation is limited, including the public sector. TRUS biopsy has low rates of severe complications, although there remains room for improvement in current practice to improve the tolerability and reduce the incidence of post-biopsy infection.
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Affiliation(s)
- Andrew Moe
- Department of Urology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
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Hawks C, Moe A, McCombie S, Hamid A, Brown M, Hayne D. 'One Stop Prostate Clinic': prospective analysis of 1000 men attending a public same-day prostate cancer assessment and/or diagnostic clinic. ANZ J Surg 2020; 91:558-564. [PMID: 32975001 DOI: 10.1111/ans.16329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study reported the outcomes of the first 1000 men to attend the One Stop Prostate Clinic, a consultant-led same-day prostate cancer assessment and diagnostic clinic at a tertiary public hospital. METHODS Prospective audit of demographic and clinical data between August 2011 and November 2017 was conducted for same-day urological assessment and/or trans-rectal ultrasound (TRUS)-guided prostate biopsies with peri-prostatic infiltration local anaesthetic (PILA) and antibiotic prophylaxis. RESULTS A total of 466 (47%) rural and 534 (53%) metropolitan men attended. Rural mean (range) age was 63 years (38-86) and 65 years (37-89) for metro men (P = 0.006). Rural median (range) prostate specific antigen (PSA) level was 6.7 g/mL (0.2-450) and 7.3 ng/mL (0.5-860) for metro men (P = 0.011). Twenty-five men (2.5%) refused/could not tolerate TRUS-guided biopsy using PILA. One hundred and fifty-one (15%) men had multi-parametric magnetic resonance imaging prior to TRUS biopsy and 876 (88%) men had prostate biopsies, with a new cancer diagnostic rate of 51% (443 men). Clinically significant prostate cancer was detected in 339 (34%) men. The overall infective complication rate requiring hospital admission rose from 1.4% to 2.9% after the prophylactic antibiotic regimen changed from six doses of 500 mg ciprofloxacin to a single dose of 500 mg (P = 0.398). CONCLUSION This is the largest single institution prospective TRUS prostate biopsy series in Australasia. Biopsies using PILA were well tolerated with low complication rates and diagnosed a high rate of clinically significant prostate cancer. The 'One Stop' pathway generates efficiencies with combined assessment and diagnostic process, lessens demand on outpatient clinic appointments and reduces travel time and costs for rural men.
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Affiliation(s)
- Cynthia Hawks
- Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
| | - Andrew Moe
- Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
| | - Steve McCombie
- Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
| | - Akhlil Hamid
- Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Matthew Brown
- Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
| | - Dickon Hayne
- Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, New South Wales, Australia
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Senturk AB, Yaytokgil M, Ekici M, Sari S, Demir E, Çakiroglu B. Comparing use of lidocaine periprostatic nerve block and diclofenac suppository alone for patients undergoing transrectal ultrasound guided prostate biopsy. Cent European J Urol 2018; 71:38-42. [PMID: 29732205 PMCID: PMC5926629 DOI: 10.5173/ceju.2017.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/23/2017] [Accepted: 12/22/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The objective of this study is to make a comparison between the effectiveness of the diclo- fenac suppository alone and periprostatic local anaesthesia infiltration alone to reduce the pain during a transrectal ultrasound-guided prostate biopsy procedure. Material and methods Between January 2014 and December 2015, 100 patients from two centres who were scheduled for transrectal ultrasound guided prostate biopsy (TRUS Bx) were included in the study. Patients were divided into two groups; diclofenac suppository group (Group 1) and Lidocaine group (Group 2). After the prostate biopsy, patients were requested to fill out a visual analogue scale in order to evaluate their pain level during the procedure. RESULTS Since each group had been examined for VAS score, statistical differences were detected for VAS 0 and VAS 1. VAS 0 score was stated in 38 (71%) patients in Group 2, and in 25 (50%) patients in Group 1 (p = 0.040). VAS 1 score was stated in 9 (17%) patients in group 2 and 19 (38%) patients in Group 1 (p = 0.030). CONCLUSIONS Although statistical difference was detected at lower VAS scores (0 and 1) in favor of the lidocaine group during transrectal ultrasound guided prostate biopsies, there was not a significant difference in higher (>2) VAS scores; which was made with 100 mg of diclofenac suppository. Therefore, diclofenac suppository can be used as an alternative to periprostatic nerve block made with lidocaine.
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Affiliation(s)
- Aykut Bugra Senturk
- Department of Urology, Hitit University, Erol Olcok Training and Research Hospital, Corum, Turkey
| | | | - Musa Ekici
- Department of Urology, Hitit University, Erol Olcok Training and Research Hospital, Corum, Turkey
| | - Sercan Sari
- Department of Urology, Sarikamis State Hospital, Kars, Turkey
| | - Emre Demir
- Department of Bioistatistics, Hitit University, Corum, Turkey
| | - Basri Çakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
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Yan P, Wang XY, Huang W, Zhang Y. Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis. J Pain Res 2016; 9:787-796. [PMID: 27785093 PMCID: PMC5067058 DOI: 10.2147/jpr.s117451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS A literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale. RESULTS A total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: -0.22, 95% CI: -0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: -1.32, 95% CI: -1.68 to -0.95, P<0.00001), placebo injection (WMD: -2.62, 95% CI: -3.16 to -2.07, P<0.00001), or IRLA (WMD: -1.31, 95% CI: -1.40 to -1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.45, 95% CI: -0.62 to -0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.73, 95% CI: -0.92 to -0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia. CONCLUSION This meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.
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Affiliation(s)
- Pu Yan
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Xiao-Yan Wang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Wei Huang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
| | - Yong Zhang
- Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People's Republic of China
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