The acceptability of transrectal ultrasound guided prostatic biopsy without anaesthesia

The suspicion of prostatic adenocarcinoma requires confirmatory biopsy of the prostate. The transrectal ultrasound scanner (TRUS) allows visualisation of the prostate and accurate placement of the biopsy needle. Traditionally this procedure has been performed under general anaesthetic. More recently however, there has been a trend to carry out TRUS and biopsy without anaesthetic. The acceptability of this procedure has never been formally investigated in a New Zealand population. The aim of this study was to determine the acceptability of TRUS and prostatic biopsy without anaesthesia.

One hundred consecutive patients undergoing TRUS guided prostatic biopsy without anaesthetic were included in the study. The indications for biopsy were an elevated serum prostate-specific antigen or an abnormal gland on digital rectal examination. The procedure was performed by the same surgeon on each occasion, using the same equipment (6 MHz multiplanar transrectal probe with 18 gauge biopsy needle) and standard techniques (left lateral position, sextant biopsies). The patients were contacted by telephone a minimum of three months after the procedure and were asked a set of standardised questions about their experience.

Seventy-nine percent of patients found the procedure only slightly, or not at all, uncomfortable. Despite the fact that 21% of the patients would prefer the same technique (no anaesthetic) if they were to require a further biopsy. Those patients who felt that they would prefer a general anaesthetic if they had to have a future biopsy were on average younger and had a significantly higher discomfort score.

Transrectal ultrasound scanning and biopsy without anaesthetic is well tolerated by New Zealand men.