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Turchi B, Lombardo R, Franco A, Tema G, Nacchia A, Cicione A, Pastore AL, Carbone A, Fuschi A, Franco G, Tubaro A, De Nunzio C. Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial. Curr Oncol 2024; 31:747-758. [PMID: 38392049 PMCID: PMC10887997 DOI: 10.3390/curroncol31020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University of Rome, 00100 Rome, Italy; (B.T.); (R.L.); (A.F.); (G.T.); (A.N.); (A.C.); (A.L.P.); (A.C.); (A.F.); (G.F.); (A.T.)
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Lombardo R, Tema G, Nacchia A, Mancini E, Franco S, Zammitti F, Franco A, Cash H, Gravina C, Guidotti A, Gallo G, Ghezzo N, Cicione A, Tubaro A, Autorino R, De Nunzio C. Role of Perilesional Sampling of Patients Undergoing Fusion Prostate Biopsies. Life (Basel) 2023; 13:1719. [PMID: 37629576 PMCID: PMC10455324 DOI: 10.3390/life13081719] [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: 06/09/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Recently, researchers have proposed perilesional sampling during prostate biopsies to avoid systematic biopsies of patients at risk of prostate cancer. The aim of our study is to evaluate the role of perilesional sampling to avoid systematic biopsies of patients undergoing fusion biopsies. A prospective cohort of patients undergoing transrectal MRI transrectal fusion biopsies were consecutively enrolled. All the patients underwent systematic biopsies (SB), targeted biopsies (TB) and perilesional biopsies within 10 mm from the lesion (PB). The detection rates of different strategies were determined. A total of 262 patients were enrolled. The median age of those enrolled was 70 years. The mean BMI was 27 kg/m2, and the mean and prostate volume was 52 mL. A PIRADS score ≥ 4 was recorded in 163/262 (40%) patients. Overall, the detection rates of cancer were 43.5% (114/262) and 35% (92/262) for csPCa. The use of the target + peri-target strategy resulted in a detection of 32.8% (86/262) of cancer cases and of 29% (76/262) of csPCa cases (Grade Group > 2). Using the target plus peri-target approach resulted in us missing 18/262 (7%) of the csPCa cases, avoiding the diagnosis of 8/262 (3%) of nsPCa cases. A biopsy strategy including lesional and perilesional sampling could avoid unnecessary prostate biopsies. However, the risk of missing significant cancers is present. Future studies should assess the cost-benefit relationship of different strategies.
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Affiliation(s)
- Riccardo Lombardo
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Giorgia Tema
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Antonio Nacchia
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Elisa Mancini
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Sara Franco
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Filippo Zammitti
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Antonio Franco
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Hannes Cash
- Department of Urology, University of Magdeburg, 39106 Magdeburg, Germany;
| | - Carmen Gravina
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Alessio Guidotti
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Giacomo Gallo
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Nicola Ghezzo
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Antonio Cicione
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Andrea Tubaro
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Riccardo Autorino
- Department of Urology, University of Chicago, Chicago, IL 60637, USA;
| | - Cosimo De Nunzio
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
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DE Nunzio C, Nacchia A, Lombardo R, Brassetti A, Sica A, Baldassarri V, Guarnotta G, Al Salhi Y, Tuderti G, Li Marzi V, Finazzi Agrò E, Pastore A, Carbone A, Simone G, Tubaro A. Effect of vacation on urinary symptoms in health care workers: an Italian multicenter study. Minerva Urol Nephrol 2022; 74:755-760. [PMID: 33781024 DOI: 10.23736/s2724-6051.21.04274-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Aim of our study was to assess the impact of vacation on urinary symptoms in health care workers. METHODS Between March 2018 to October 2019 a survey was carried out by enrolling health care system workers in three centers. Demographic and clinical characteristics of health care workers (i.e. age, smoking status, medical history) were collected. Lower urinary tract symptoms (LUTS) and work related quality of life were assessed before and after vacation with validated questionnaires: Overactive Bladder Questionnaire Short Form (OABq-sf), International Prostate Symptom Score (IPSS), Work-related Quality of Life (WRQOL) and SF-36 questionnaires. As well, night shift workers (NSWs), defined as working at least one time a week from 8 pm to 8 am, were compared to traditional workers (TWs). RESULTS A total of 236 participants (118 males and 118 females) with a median of 41 (32/49 IQR) years old were included in the survey. Healthcare workers presented after vacation an improvement in LUTS, in work related quality of life and overall health. Overall, 89 (37%) were NSWs and 147 (62%) subjects were TWs. NSWs reported a significant higher median OABq Total Score and IPSS than TWs: respectively, 27 (IQR 23-34) vs. 20 (IQR 19-24) P=0.01, 2 (0/6) vs. 0 (0/2) (P<0.01). No significative differences were found for WRQOL and SF36, respectively 66 (IQR 59/77) vs. 67 (IQR 61/82) (P<0.29) and 98 (97/101) vs. 98 (97/100) (P<0.79). CONCLUSIONS NSWs present worst urinary symptoms when compared to TWs. Vacation has a beneficial effect, particularly in NSWs, on urinary symptoms and work-related quality of life.
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Affiliation(s)
| | | | | | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Angela Sica
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | | | | | - Yazan Al Salhi
- Department of Urology, Traumatological Orthopedic Surgical Institute, Latina, Italy
| | - Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Li Marzi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Antonio Pastore
- Department of Urology, Traumatological Orthopedic Surgical Institute, Latina, Italy
| | - Antonio Carbone
- Department of Urology, Traumatological Orthopedic Surgical Institute, Latina, Italy
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
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Rotterdam mobile phone app including MRI data for the prediction of prostate cancer: A multicenter external validation. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2640-2645. [PMID: 33965292 DOI: 10.1016/j.ejso.2021.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The Rotterdam Prostate Cancer Risk calculator (RPCRC) has been validated in the past years. Recently a new version including multiparametric magnetic resonance imaging (mpMRI) data has been released. The aim of our study was to analyze the performance of the mpMRI RPCRC app. METHODS A series of men undergoing prostate biopsies were enrolled in eleven Italian centers. Indications for prostate biopsy included: abnormal Prostate specific antigen levels (PSA>4 ng/ml), abnormal DRE and abnormal mpMRI. Patients' characteristics were recorded. Prostate cancer (PCa) risk and high-grade PCa risk were assessed using the RPCRC app. The performance of the mpMRI RPCRC in the prediction of cancer and high-grade PCa was evaluated using receiver operator characteristics, calibration plots and decision curve analysis. RESULTS Overall, 580 patients were enrolled: 404/580 (70%) presented PCa and out of them 224/404 (55%) presented high-grade PCa. In the prediction of cancer, the RC presented good discrimination (AUC = 0.74), poor calibration (p = 0.01) and a clinical net benefit in the range of probabilities between 50 and 90% for the prediction of PCa (Fig. 1). In the prediction of high-grade PCa, the RC presented good discrimination (AUC = 0.79), good calibration (p = 0.48) and a clinical net benefit in the range of probabilities between 20 and 80% (Fig. 1). CONCLUSIONS The Rotterdam prostate cancer risk App accurately predicts the risk of PCa and particularly high-grade cancer. The clinical net benefit is wide for high-grade cancer and therefore its implementation in clinical practice should be encouraged. Further studies should assess its definitive role in clinical practice.
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Tolani MA, Ahmed M, Lawal AT, Fidelis L, Sudi A, Hamza BK, Awaisu M, Nasir O, Bello A, Maitama HY. Comparison of the tolerability and efficacy of intra-rectal lidocaine gel with peri-prostatic nerve block as anaesthetic techniques for prostate biopsy. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Prostate biopsy is a painful procedure. However, over the years, varied opinions exist among urologists about the methods of achieving optimal pain relief for the procedure. The purpose of this study was to compare the tolerability of administration and the efficacy of intra-rectal lidocaine gel with peri-prostatic nerve block for this procedure.
Methods
From June 2016 to June 2017, 110 patients who met the study criteria were randomized to receive either intra-rectal lidocaine gel (Group 1) or an apical peri-prostatic nerve block (Group 2) for prostate biopsy. Their level of pain perception during the anaesthesia administration and the prostate biopsy was assessed using the Numeric Rating Scale. Other biopsy-related complications and patient satisfaction were also evaluated. Grouped data were compared using student t test and Chi-square with p < 0.05 considered significant.
Results
The pain score during the administration of anaesthesia was 1.6 ± 1.9 and 3.7 ± 2.1 for the intra-rectal lidocaine gel and peri-prostatic nerve block groups, respectively (p = 0.001). However, during the prostate biopsy, the pain score was 6.8 ± 2.2 and 2.9 ± 1.9 for the intra-rectal lidocaine gel and peri-prostatic nerve block groups, respectively (p = 0.001). There was a significantly lower rate of satisfaction (45.3% versus 86.8%, p = 0.001) in the lidocaine gel group.
Conclusions
Although intra-rectal lidocaine gel administration is better tolerated by patients, a peri-prostatic nerve block is more effective and provides better patient satisfaction than intra-rectal lidocaine gel when used as anaesthesia for prostate biopsy.
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Lombardo R, Tema G, Cancrini F, Albanesi L, Mavilla L, Tariciotti P, Gentile BC, Aloisi P, Rizzo G, Tardioli S, Giulianelli R. The role of immune PSA complex (iXip) in the prediction of prostate cancer. Biomarkers 2020; 26:26-30. [PMID: 33100063 DOI: 10.1080/1354750x.2020.1841294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyse the performance of iXip in the prediction of prostate cancer (PCa) and high-grade PCa. METHODS A consecutive series of men undergoing MRI/FUSION prostate biopsies were enrolled in one centre. Indications for prostate biopsy included abnormal prostate-specific antigen (PSA) levels (PSA > 4 ng/ml) and/or abnormal digital rectal examination (DRE) and/or abnormal MRI. All patients underwent the evaluation of serum PSA-IgM concentration and the iXip ratio was calculated. Accuracy iXip for the prediction of PCa was evaluated using multivariable binary regression analysis and receiver operator characteristics (ROC) curves. RESULTS Overall 160 patients with a median age of 65 (62/73) years were enrolled. Overall, 42% patients were diagnosed with PCa and 75% of them had high-grade cancer (Epstein ≥ 3). Patients with PCa were older and presented higher PSA levels, higher PIRADS scores and lower prostate volumes (PVs). On ROC analysis iXip presented an area under the curve (AUC) of 0.57 in the prediction of PCa and of 0.54 for the prediction of high-grade PCa. CONCLUSIONS In our experience, immune PSA complexes are not predictors of PCa. iXip analysis should not be included in the diagnostic pathway of patients at increased risk of PCa.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Fabiana Cancrini
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Luca Albanesi
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Luca Mavilla
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Paola Tariciotti
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | | | - Pietro Aloisi
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Giorgio Rizzo
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Stefano Tardioli
- Department of Urology, Casa di Cura Nuova Villa Claudia, Rome, Italy
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Kim DK, Lee JY, Jung JH, Hah YS, Koo KC, Lee KS, Chung BH, Cho KS. What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials. Sci Rep 2019; 9:4901. [PMID: 30894638 PMCID: PMC6426994 DOI: 10.1038/s41598-019-41412-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/08/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB + IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, IVS, and PNB. In conclusion, the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, and PNB methods are potentially more acceptable options.
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Affiliation(s)
- Do Kyung Kim
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hung Jung
- Department of Urology, Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yoon Soo Hah
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Yang Y, Liu Z, Wei Q, Cao D, Yang L, Zhu Y, Wei X, Tang Z, Liu L, Han P. The Efficiency and Safety of Intrarectal Topical Anesthesia for Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis. Urol Int 2017; 99:373-383. [DOI: 10.1159/000481830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022]
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Li M, Wang Z, Li H, Yang J, Rao K, Wang T, Wang S, Liu J. Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis. Sci Rep 2017; 7:40421. [PMID: 28079154 PMCID: PMC5227686 DOI: 10.1038/srep40421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 12/06/2016] [Indexed: 11/09/2022] Open
Abstract
A meta-analysis was performed to evaluate the efficacy of local anesthesia in alleviating pain during prostate biopsy. We searched relevant articles in PubMed and Embase. The included studies should be randomized controlled trials (RCT) using local anesthesia to alleviate pain during biopsy, which was recorded by a pain scale. Analgesic efficacy of different local anesthesia techniques were analyzed, including intrarectal local anesthesia (IRLA), periprostatic nerve block (PNB), pelvic plexus block (PPB) and intraprostatic local anesthesia (IPLA). We included 46 RCTs. PNB significantly reduced pain score compared with placebo (-1.27 [95% confidence interval [95% CI] -1.72, -0.82]) or no injection (-1.01 [95% CI -1.2, -0.82]). IRLA with prilocaine-lidocaine cream could also reduced pain (-0.45 [95% CI -0.76, -0.15]), while the IRLA with lidocaine gel was not effective (-0.1 [95% CI -0.24, 0.04]). PNB lateral to the neurovascular bundle had better analgesic effect than at prostate apex (P = 0.02). Combination use of PPB and IRLA considerably alleviated pain of patients compared with the combination of PNB and IRLA (-1.32 [95% CI -1.59, -1.06]). In conclusion, local anesthesia could alleviate patients' pain during the prostate biopsy. PNB was not so effective as PPB.
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Affiliation(s)
- Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhengyun Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Ke Rao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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10
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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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De Nunzio C, Lombardo R, Presicce F, Bellangino M, Agro EF, Gambrosier MB, Trucchi A, Petta S, Tubaro A. Transrectal-ultrasound prostatic biopsy preparation: rectal enema vs. mechanical bowel preparation. Cent European J Urol 2015; 68:223-8. [PMID: 26251750 PMCID: PMC4526619 DOI: 10.5173/ceju.2015.608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/13/2015] [Accepted: 04/24/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Transrectal prostate biopsy (TRUSbx) is the standard for the diagnosis of prostate cancer. Different bowel preparations are used for patients undergoing TRUSbx. The aim of our study was to compare two different bowel preparations for TRUSbx. MATERIAL AND METHODS From May 2012 and onwards, a selected group of men undergoing TRUS 12-core prostate biopsy were enrolled into a prospective database. Patients were randomized 1:1 to receive a rectal enema (Group A) the night before the procedure or polyethylene glycol 34.8 grams/4 liters of water the day before the procedure (Group B). A VAS scale to evaluate the patients' discomfort according to the two preparations was collected. The same antibiotic prophylaxis was performed in both groups. All complications were prospectively recorded and graded according to the Clavien Classification System (CCS). RESULTS A total of 198 patients were consecutively enrolled. Mean age was 67.5 ±7.9 years, mean body mass index (BMI) was 27.1 ±4.2 Kg/m(2), mean PSA value was 9.3 ±12.6 ng/ml and the mean prostatic volume was 60.6 ±29 ml. 97 patients were enrolled in Group A and 101 in Group B. Overall post-biopsy morbidity rate was 60%. No significant differences for low-grade and high-grade complications was observed between the two groups. Patients receiving the rectal enema presented with a significantly lower VAS score (3.1 ±1.1 vs. 5.9 ±1.7; p = 0.02). CONCLUSIONS Our study confirmed that a rectal enema should be considered as the standard bowel preparation in patients undergoing a TRUS biopsy; it is as effective as PEG and associated with less discomfort.
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12
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Ooi WL, Hawks C, Tan AH, Hayne D. A randomised controlled trial comparing use of lignocaine periprostatic nerve block alone and combined with diclofenac suppository for patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. BJU Int 2014; 114 Suppl 1:45-9. [PMID: 25302456 DOI: 10.1111/bju.12610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Ling Ooi
- University of Western Australia; School of Surgery; Perth Western Australia Australia
- Department of Urology; Fremantle Hospital; Perth Western Australia Australia
| | - Cynthia Hawks
- Department of Urology; Fremantle Hospital; Perth Western Australia Australia
- West Australian Urologic Research Organisation; Perth Western Australia Australia
| | - Andrew H.H. Tan
- West Australian Urologic Research Organisation; Perth Western Australia Australia
| | - Dickon Hayne
- University of Western Australia; School of Surgery; Perth Western Australia Australia
- Department of Urology; Fremantle Hospital; Perth Western Australia Australia
- West Australian Urologic Research Organisation; Perth Western Australia Australia
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13
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Lee C, Woo HH. Current methods of analgesia for transrectal ultrasonography (TRUS)-guided prostate biopsy - a systematic review. BJU Int 2014; 113 Suppl 2:48-56. [DOI: 10.1111/bju.12433] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chanyang Lee
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
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Cicione A, Cantiello F, De Nunzio C, Tubaro A, Damiano R. Needle biopsy size and pathological Gleason Score diagnosis: No evidence for a link. Can Urol Assoc J 2013; 7:E567-71. [PMID: 24069097 DOI: 10.5489/cuaj.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Biopsy Gleason score (GS), in combination with other clinical parameters, is important to take a therapeutic decision for patients with diagnosis of localized prostate cancer. However, preoperative GS is often upgraded after a radical prostatectomy. Increasing the amount of tissue in prostate biopsy may be a way to avoid this issue. We evaluate the influence of a larger biopsy needle size on the concordance between biopsy and pathological GS. METHODS We analyzed paired biopsies and prostatectomy specimens from 104 cases of men with clinically localized prostate cancer. At the time of prostate biopsy, the patients were prospectively randomized into two needle groups (16-Gauge [G] and 18G) using a 1:1 ratio. GS concordance was estimated performing kappa statistic testing, overall concordance rate and risk to under grade biopsy GS=6. A logistic regression analysis was performed to evaluate the patients' characteristics as possible risk factors. RESULTS The overall concordance between prostate biopsy and pathological GS was 76.9% and 75.6% (p = 0.875) and the k values were 0.821 and 0.811 (p = 0.424), respectively, for 16G and 18G needle study groups. The risk to undergrade a biopsy GS=6 was 21.1% and 15.4% (p = 0.709) using a 16G and 18G needle, respectively. Age, prostate-specific antigen, prostate volume and needle calibre were not independently associated with a higher risk of GS discordance. CONCLUSIONS Needle size does not affect the concordance between biopsy and pathological GS. Although GS is not the only way to determine treatment, it is still an unresolved urological issue.
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Affiliation(s)
- Antonio Cicione
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
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15
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Cicione A, Cantiello F, De Nunzio C, Tubaro A, Damiano R. Patients with metabolic syndrome and widespread high grade prostatic intraepithelial neoplasia are at a higher risk factor of prostate cancer on re-biopsy: a prospective single cohort study. Urol Oncol 2012; 32:28.e27-31. [PMID: 23273912 DOI: 10.1016/j.urolonc.2012.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/05/2012] [Accepted: 10/05/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To test the hypothesis that patients with widespread high grade prostatic intra epithelial neoplasia (wHGPIN) and metabolic syndrome (MetS) are at a higher risk of prostate cancer (PCa) at a repeat biopsy. METHODS AND MATERIALS We prospectively evaluated 161 patients submitted from December 2004 to December 2011 to prostate rebiopsy after a initial diagnosis of HGPIN in a tertiary academic center. A 12 core biopsy template was used for all the biopsies. Rebiopsy was performed six months after the initial biopsy independently from PSA level and the DRE finding. wHGPIN was defined as≥4 biopsy cores involved. MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III criteria. RESULTS Overall, 64 patients (39.7%) presented wHGPIN and 97 isolated HGPIN (60.3%). MetS was found in 63 patients, 39.1% of the whole population. Out of them 16 (25.3%) and 47 (74.7%) patients had a diagnosis of isolated and wHGPIN (P = 0.001). PCa detection rate at repeat biopsy was significantly higher in patients with MetS and wHGPIN than in those with wHGPIN and no MetS (57.4% Vs 23.5%; P = 0.016). A logistic regression model confirmed that wHGPIN and MetS are independent risk factors of prostate cancer diagnosis (respectively: Odds ratio (OR) = 4.187, 95%CI: 1.65-10.57 p = 0.002 and OR=3.603, 95%CI: 1.41-9.19, p = 0.007). CONCLUSION Patients with MetS and wHGPIN are at a higher risk of PCa, therefore performing a new prostate biopsy in those patients should be recommended.
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Affiliation(s)
- Antonio Cicione
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | | | - Cosimo De Nunzio
- La Sapienza University, Department of Urology, Sant' Andrea Hospital, Rome, Italy
| | - Andrea Tubaro
- La Sapienza University, Department of Urology, Sant' Andrea Hospital, Rome, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
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16
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Kang KS, Yeo JK, Park MG, Cho DY, Park SH, Park SS. Efficacy of Periprostatic Anesthesia according to Lidocaine Dose during Transrectal Ultrasound-Guided Biopsy of the Prostate. Korean J Urol 2012. [PMID: 23185665 PMCID: PMC3502732 DOI: 10.4111/kju.2012.53.11.750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of periprostatic lidocaine injection according to lidocaine dose during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS The subjects of this study were 92 patients who had undergone transrectal ultrasound-guided 12-core biopsy of the prostate. The patients were randomly assigned to three groups: group 1 (n=31, no lidocaine injection), group 2 (n=30, periprostatic injection of 10 ml 1% lidocaine), and group 3 (n=31, periprostatic injection of 20 ml 1% lidocaine). The patients were assessed for pain by use of a 10-point visual analogue scale (VAS) and for other complications after the procedure. RESULTS The mean VAS scores of groups 1 through 3 were 0.93±0.89, 1.32±1.37, and 1.13±1.10, respectively. There were no statistically significant differences between the three groups. However, the mean VAS score of the biopsy pain was 5.0±1.48, 3.93±1.94, and 3.60±2.15, in the same groups, respectively, with statistically significant differences between group 1 and the other groups. Patients in groups 2 and 3 reported significantly less biopsy pain than did group 1 patients (p=0.004, 0.021), with no statistically significant difference in VAS score between groups 2 and 3 (p=0.533). With respect to post-biopsy complications, there were no significant differences in the incidence of hematuria, hematospermia, rectal bleeding, or infection among the three groups. CONCLUSIONS Periprostatic injection of local anesthesia with lidocaine was associated with significantly less pain than in the absence of anesthesia. Furthermore, a 20-ml dose of lidocaine produced no better pain control than did a 10-ml lidocaine dose for prostate biopsy.
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Affiliation(s)
- Kyung Seok Kang
- Department of Urology, Inje University Seoul Paik Hospital, Seoul, Korea
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17
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Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F. Applications of transrectal ultrasound in prostate cancer. Br J Radiol 2012; 85 Spec No 1:S3-17. [PMID: 22844031 DOI: 10.1259/bjr/56357549] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Transrectal ultrasound (TRUS) was first developed in the 1970s. TRUS-guided biopsy, under local anaesthetic and prophylactic antibiotics, is now the most widely accepted method to diagnose prostate cancer. However, the sensitivity and specificity of greyscale TRUS in the detection of prostate cancer is low. Prostate cancer most commonly appears as a hypoechoic focal lesion in the peripheral zone on TRUS but the appearances are variable with considerable overlap with benign lesions. Because of the low accuracy of greyscale TRUS, TRUS-guided biopsies have become established in the acquisition of systematic biopsies from standard locations. The number of systematic biopsies has increased over the years, with 10-12 cores currently accepted as the minimum standard. This article describes the technique of TRUS and biopsy and its complications. Novel modalities including contrast-enhanced modes and elastography as well as fusion techniques for increasing the sensitivity of TRUS-guided prostate-targeted biopsies are discussed along with their role in the diagnosis and management of prostate cancer.
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Affiliation(s)
- C J Harvey
- Department of Imaging, Imperial Healthcare Trust, Hammersmith Hospital, London, UK.
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18
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Cicione A, Cantiello F, De Nunzio C, Tubaro A, Damiano R. Prostate Biopsy Quality Is Independent of Needle Size: A Randomized Single-Center Prospective Study. Urol Int 2012; 89:57-60. [DOI: 10.1159/000339250] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/04/2012] [Indexed: 01/28/2023]
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Affiliation(s)
- Assaad El-Hakim
- Assistant Professor of Urology, McGill University, Montréal, QC
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20
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Tubaro A, De Nunzio C, Mariani S, Trucchi A, Miano R, Vicentini C, Miano L. Reduction of prostate-specific antigen after tamsulosin treatment in patients with elevated prostate-specific antigen and lower urinary tract symptoms associated with low incidence of prostate cancer at biopsy. Urology 2010; 76:436-41. [PMID: 20538320 DOI: 10.1016/j.urology.2009.12.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 12/29/2009] [Accepted: 12/29/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the effect of tamsulosin on reducing the serum levels of prostate-specific antigen (PSA) in patients with lower urinary tract symptoms and an elevated PSA level. METHODS From June 2004 to July 2006, patients with lower urinary tract symptoms, a PSA level of >or=4 ng/mL, and a maximal flow rate of <15 mL/s received tamsulosin 0.4 mg daily for 2 months. They were then scheduled for 12-core prostate biopsy. PSA determination and a uroflow study were performed before biopsy. RESULTS A total of 80 patients completed the present study. The mean patient age was 66.3 years, and the mean PSA level was 7.8 +/- 8.4 ng/mL at baseline and 7.1 +/- 9.1 ng/mL after treatment (P < .001). A total of 29 patients (36.25%) were diagnosed with prostate cancer from the biopsy findings. A significant increment in the PSA level was observed in patients with prostate cancer (6.7 versus 7.9 ng/mL; P = .002). A significant decrease in the PSA level was observed in patients with negative biopsy findings (6.9 versus 5.1 ng/mL, P = .000). Of the 38 patients with a decrease in the PSA level, 1 (2.6%) was diagnosed with prostate cancer and 37 (97.4%) with an benign prostatic hyperplasia/prostatitis. Of the 42 patients with no change in the PSA level, 28 (66.7%) had prostate cancer and 14 (33.3%) had negative findings. A change in PSA level after treatment gave a sensitivity of 96.6%, specificity of 72.5%, and diagnostic accuracy of 81% for prostate cancer. CONCLUSIONS Treatment with tamsulosin seemed to reduce the PSA levels and identified patients at high risk of prostate cancer.
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Affiliation(s)
- Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital 2nd School of Medicine, "La Sapienza" University of Rome, Rome, Italy.
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21
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İĞDEM Ş, AKPINAR H, ALÇO G, AĞAÇAYAK F, TURKAN S, OKKAN S. Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity. Br J Radiol 2009; 82:941-5. [DOI: 10.1259/bjr/14201041] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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De Nunzio C, Trucchi A, Miano R, Stoppacciaro A, Fattahi H, Cicione A, Tubaro A. The Number of Cores Positive for High Grade Prostatic Intraepithelial Neoplasia on Initial Biopsy is Associated With Prostate Cancer on Second Biopsy. J Urol 2009; 181:1069-74; discussion 1074-5. [DOI: 10.1016/j.juro.2008.10.163] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Cosimo De Nunzio
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Alberto Trucchi
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Roberto Miano
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Antonella Stoppacciaro
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Hassan Fattahi
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Antonio Cicione
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Andrea Tubaro
- Departments of Urology and Pathology (AS), Sant'Andrea Hospital, University La Sapienza, and Department of Urology (RM), Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
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23
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Lee L, Pilcher J. The role of transrectal ultrasound and biopsy in the diagnosis and management of prostate cancer. IMAGING 2008. [DOI: 10.1259/imaging/41490379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tubaro A, De Nunzio C, Trucchi A, Stoppacciaro A, Miano L. The electromagnetic detection of prostatic cancer: evaluation of diagnostic accuracy. Urology 2008; 72:340-4. [PMID: 18336888 DOI: 10.1016/j.urology.2007.11.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 10/23/2007] [Accepted: 11/12/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the accuracy of the TRIMprob in the diagnosis of prostate neoplasm. METHODS Consecutive patients referred for prostate biopsy were prospectively enrolled. Patients had history taken, physical examination by digital rectal examination (DRE) of the prostate, assessment of total and free serum prostate-specific antigen (PSA) levels, prostate transrectal ultrasonography (TRUS), and TRIMprob test. Indications for prostate biopsy included one or more of the following conditions: total serum PSA levels of 4.0 ng/mL or more, free/total serum PSA ratio of 0.18 or less, positive results on DRE, and suspicious findings on TRUS. Twelve-core, TRUS-guided biopsies were performed with local anesthesia. A blinded investigator performed the TRIMprob test; the lowest value of the signal at 465 MHz was looked for and recorded, although data of the electromagnetic signal at 930 and 1295 MHz were also recorded. RESULTS One hundred eleven patients (aged 64.9 +/- 8.1 years, mean +/- standard deviation), enrolled between November 2004 and August 2005, were analyzed. Total serum PSA level was 8.4 +/- 3.6 ng/mL, and free/total serum PSA ratio was 0.15 +/- 0.7. TRIMprob sensitivity for the diagnosis of prostate cancer was 0.86%; specificity and positive and negative predictive values were 0.60 and 0.88; accuracy was 72%. TRIMprob accuracy outperformed any other diagnostic parameter considered, including the rule of chance. The association of TRIMprob and DRE offered a sensitivity and a negative predictive value of 0.86% or greater. CONCLUSIONS TRIMprob had the highest accuracy rate, among all other tests, for the diagnosis of prostate cancer. Electromagnetic detection with the TRIMprob test seems to be a promising technology and a useful additional tool for the early detection of prostate cancer.
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Affiliation(s)
- Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, 2nd School of Medicine, La Sapienza University of Rome, Rome, Italy.
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25
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Szlauer R, Götschl R, Gnad A, Meissner P, Paras L, Schmeller NT, Fink KG. Comparison of Lidocaine Suppositories and Periprostatic Nerve Block during Transrectal Prostate Biopsy. Urol Int 2008; 80:253-6. [DOI: 10.1159/000127336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 07/04/2007] [Indexed: 11/19/2022]
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Hergan L, Kashefi C, Parsons JK. Local anesthetic reduces pain associated with transrectal ultrasound-guided prostate biopsy: a meta-analysis. Urology 2007; 69:520-5. [PMID: 17382157 DOI: 10.1016/j.urology.2006.12.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 09/14/2006] [Accepted: 12/08/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether local anesthetic decreases the pain associated with transrectal ultrasound-guided prostate needle biopsy. METHODS A systematic review and meta-analysis was performed of randomized clinical trials of periprostatic local anesthetic for prostate biopsy. The primary outcome was pain as determined by the visual analog scale. The standardized mean differences between groups were estimated using the DerSimonian and Laird random effects models. RESULTS Fourteen trials with a total of 994 patients met the inclusion criteria for this study. Pooled data analysis demonstrated significantly decreased pain with the use of local anesthetic. The standardized mean difference in the pain score comparing local anesthetic to placebo or nothing was -1.05 (95% confidence interval -1.40 to -0.71, P <0.001). Begg's test (P = 0.34) and Egger's test (P = 0.50) showed no evidence of significant publication bias. Sensitivity analysis showed only slight changes in the effect estimate with sequential omission of each trial or with repetition of the analysis with subgroups of trials based on likely sources of heterogeneity. CONCLUSIONS The results of our analysis have shown that compared with no anesthetic, periprostatic local anesthetic significantly decreases the pain associated with transrectal ultrasound-guided prostate needle biopsy.
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Affiliation(s)
- Lori Hergan
- Division of Urology, University of California, San Diego, School of Medicine, San Diego, California 92103-8897, USA
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27
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Tiong HY, Liew LCH, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis 2007; 10:127-36. [PMID: 17211441 DOI: 10.1038/sj.pcan.4500935] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This meta-analysis evaluated the efficacy and safety of periprostatic nerve block (PPNB) and intrarectal local anesthestic (IRLA) gel in alleviating pain during prostate biopsy. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE were searched to identify all randomized controlled trials comparing PPNB with periprostatic placebo injection, no injection or with IRLA. Studies for inclusion were identified and extracted by two authors independently. The main outcome measure was patients' assessment of mean pain scores on a 10-point scale at the end of the biopsy procedure. Secondary outcomes were complications and adverse events. Continuous data from the trials were combined by calculating the weighted mean difference (WMD) with its 95% confidence interval. In total, 25 studies met the inclusion criteria. Twenty studies involving 1685 patients compared PPNB with either no anesthesia or with placebo injection controls, showing a significant reduction in pain score in the anesthetic group (WMD -2.09, 95% CI -2.44 to -1.75, P<0.00001). Five studies with 466 patients compared IRLA and control. Although IRLA was associated with pain reduction, the effect size was not statistically significant (WMD -0.22, 95% CI -0.56 to 0.12). Six studies with 872 patients compared PPNB with IRLA, showing a significant pain reduction in the former group (WMD -1.53, 95% CI -2.67 to -0.39, P=0.008). No trials reported an increase in complications in the treatment arms. In conclusion, the evidence from randomized controlled trials shows that local anesthetic given as a PPNB, but not as an intrarectal instillation, is effective and safe in alleviating pain from transrectal ultrasound biopsy of the prostate.
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Affiliation(s)
- H Y Tiong
- Department of Urology, National University Hospital, Singapore, Singapore.
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Song SH, Kim JK, Song K, Ahn H, Kim CS. Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Int J Urol 2006; 13:707-10. [PMID: 16834647 DOI: 10.1111/j.1442-2042.2006.01390.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS Ninety men undergoing transrectal prostate biopsy from July through December 2004 were randomized into three groups of 30 patients each. Before the biopsy, patients in Group 1 received 20 mL of 2% lidocaine gel intrarectally; patients in Group 2 received 5 mL (2.5 mL per side) of 2% lidocaine solution injected near the junction of the seminal vesicle with the base of the prostate (along the neurovascular bundles), and patients in Group 3 (control group) received 5 mL (2.5 mL per side) of normal saline injected along the neurovascular bundles. Pain level after the biopsy was assessed using a 10-point linear visual analog scale (VAS). Results were statistically compared by the Wilcoxon Rank Sum test. RESULTS Patients in Group 2 had significantly lower VAS scores than those in Group 3 (3.6 +/- 2.1 vs 5.8 +/- 1.9, P < 0.0001), but those in Group 1 did not (5.5 +/- 2.7 vs 5.8 +/- 1.9, P = 0.67). Gross hematuria, rectal bleeding, and hemospermia occurred in 36 (40.0%), 6 (7%) and 5 (6%) patients. One patient had temporary vasovagal syncope. No patient reported febrile urinary tract infection or urinary retention. CONCLUSIONS Periprostatic injection of local anaesthetic is a safe technique that significantly reduces pain during prostate biopsy, whereas intrarectal lidocaine injection did not reduce pain. This safe, simple technique should be applied in men undergoing TRUS-guided prostate biopsy to limit patient discomfort.
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Affiliation(s)
- Seung-Hun Song
- Department of Urology, CHA General Hospital, College of Medicine, Pochon CHA University, Seoul, Korea
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Conde Redondo C, Alonso Fernández D, Robles Samaniego A, Del Valle González N, Castroviejo Royo F, Delgado Marcos C, Rodríguez Toves A, Martínez-Sagarra Oceja JM. [TRUS-guided biopsy: comparison of two anesthetic methods]. Actas Urol Esp 2006; 30:134-8. [PMID: 16700202 DOI: 10.1016/s0210-4806(06)73414-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2% mevicaine. PATIENTS AND METHODS A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. RESULTS There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3 +/- 1.3), and 10 in group II (5 +/- 1.2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS = 5-6) and 3% strong pain (VAS = 7-8); while patients in group I referred 12.5% no pain, 42.4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p < or = 0.05). There were no significant differences in major complications. CONCLUSIONS The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores.
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Richman JM, Carter HB, Hanna MN, Murphy JD, Rowlingson AJ, Andrews RAF, Wu CL. Efficacy of periprostatic local anesthetic for prostate biopsy analgesia: A meta-analysis. Urology 2006; 67:1224-8. [PMID: 16765183 DOI: 10.1016/j.urology.2005.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 11/21/2005] [Accepted: 12/14/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To perform a meta-analysis of available randomized trials investigating the analgesic efficacy of periprostatic block with local anesthetic. METHODS The National Library of Medicine's PubMed database was searched for the time period 1966 to August 16, 2005 for all relevant articles. Inclusion criteria included subjects undergoing prostate biopsy, trials that were randomized with one arm of the randomization using local anesthetic for periprostatic block before prostate biopsy, and where the assessment of biopsy pain was measured and available in a form compatible for statistical analysis in our meta-analysis. RESULTS Our search resulted in 107 abstracts, of which a total of 16 articles met all inclusion criteria. There were 660 subjects who received local anesthetics for a periprostatic block and 616 subjects who did not. The weighted mean difference between the groups indicates that subjects receiving local anesthetic periprostatic block would have a statistically lower pain score compared with those who did not (weighted mean difference in visual analogue pain of -1.66 [95% confidence interval -2.03 to -1.29]). CONCLUSIONS Our meta-analysis suggests that periprostatic block with local anesthetic for prostate biopsy might result in significantly lower levels of pain during the biopsy procedure. Because periprostatic block with local anesthetic is relatively easy to administer and does not seem to be associated with increased morbidity, clinicians performing prostate biopsies should consider using this technique on a routine basis.
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Affiliation(s)
- Jeffrey M Richman
- Department of Anesthesiology, The Johns Hopkins University, Baltimore, Maryland 21287, USA
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