Risk factors associated with pain in fusion prostate biopsy

Multiparametric prostate magnetic resonance imaging (mpMRI)-guided fusion prostate biopsy is an emerging technique in the diagnosis of prostate cancer and provides extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. We aimed to investigate the clinical and anatomical risk factors aggravating the pain experienced by patients undergoing mpMRI-guided fusion prostate biopsy.

The prospective study included 319 patients aged 45-75 years who had a prostate-specific antigen <10 ng/ml and a Prostate Imaging Reporting and Data System ≥3 lesion and underwent combined biopsy (targeted biopsy + 12-core standard prostate biopsy) under local anesthesia (intrarectal lidocaine gel + periprostatic nerve block). Immediately after the biopsy procedure, pain assessment was achieved using Visual Analog Scale (VAS). The relationship between the VAS and 13 clinical parameters was evaluated using ordinal logistic regression analysis.

The 319 patients had a mean age of 62.39 ± 6.98 years and a median prostate-specific antigen level of 7.20 (range, 5.20-8.50) ng/ml. The VAS was found to be correlated with 4 of 13 parameters, including (i) a shorter prostate-anus surface distance (cutoff value, 55.5 mm), (ii) a narrower anorectal angle (cutoff value, 106.5°), (iii) a larger total prostate volume (cutoff, 61.6 mm³), and (iv) having no history of prior biopsy (biopsy-naive patients).

Anatomical measurements that can be achieved by using mpMRI images (TPV, PASD and ARA) may be useful in the identification of patients at an increased risk of pain during biopsy and also in taking analgesic precautions in such patients.