Pain in Men Undergoing Transperineal Free-Hand Multiparametric Magnetic Resonance Imaging Fusion Targeted Biopsies under Local Anesthesia: Outcomes and Predictors from a Multicenter Study of 1,008 Patients

No AccessJournal of UrologyAdult Urology1 Dec 2020Pain in Men Undergoing Transperineal Free-Hand Multiparametric Magnetic Resonance Imaging Fusion Targeted Biopsies under Local Anesthesia: Outcomes and Predictors from a Multicenter Study of 1,008 Patients Giancarlo Marra, Junlong Zhuang, Alessandro Marquis, Xiaozhi Zhao, Giorgio Calleris, Yansheng Kan, Marco Oderda, Haifeng Huang, Riccardo Faletti, Qing Zhang, Luca Molinaro, Wei Wang, Laura Bergamasco, Hongqian Guo, and Paolo Gontero Giancarlo MarraGiancarlo Marra Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy Equal study contribution. More articles by this author , Junlong ZhuangJunlong Zhuang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China Equal study contribution. More articles by this author , Alessandro MarquisAlessandro Marquis †Correspondence: Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Cso Bramante 88/90, 10126Turin, Italy E-mail Address: [email protected] Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author , Xiaozhi ZhaoXiaozhi Zhao Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author , Giorgio CallerisGiorgio Calleris Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author , Yansheng KanYansheng Kan Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author , Marco OderdaMarco Oderda Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author , Haifeng HuangHaifeng Huang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author , Riccardo FalettiRiccardo Faletti Department of Radiology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author , Qing ZhangQing Zhang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author , Luca MolinaroLuca Molinaro Department of Pathology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author , Wei WangWei Wang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author , Laura BergamascoLaura Bergamasco Department of Radiology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author , Hongqian GuoHongqian Guo †Department of Urology, Nanjing Drum Tower Hospital and Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing210008, Jiangsu , People's Republic of China E-mail Address: [email protected] Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author , and Paolo GonteroPaolo Gontero Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001234AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Several transperineal biopsy series have proven feasibility under local anesthesia. However, there is a lack of large analyses detailing pain outcomes and factors influencing pain. Materials and Methods: From 2016 to 2019 we performed a multicenter prospective study in men undergoing multiparametric magnetic resonance imaging-transperineal fusion biopsies (target+systematic cores) under local anesthesia. Primary outcomes were 1) pain scores (assessed through a 0 to 10-point numeric rating scale) and 2) identification of factors associated with severe pain. The secondary outcome was to evaluate pain influence on clinically significant prostate cancer target cores detection. Results: We included 1,008 men undergoing transperineal fusion biopsies under local anesthesia. Mean±SD numeric rating scale pain scores were 3.9±2.1 at local anesthesia administration and 3.1±2.3 when performing biopsies. Pain was not associated with lower clinically significant prostate cancer detection on targeted cores (p=0.23 and p=0.47 depending on clinically significant prostate cancer definition). On multivariate analysis age (OR 0.96, 95% CI 0.94–0.99) and severe anxiety (OR 2.99, 95% CI 1.83–4.89) were a protective and risk factor, respectively, for severe biopsy pain. Procedural time was also associated with an increased risk of experiencing severe biopsy pain (OR 1.04, 95% CI 1.00–1.08). If aiming to test the possible effects of anxiety preventive measures on pain, an anxiety cutoff greater than 6 on a numeric rating scale would decrease to 13% the number of patients being treated while identifying 56% of those experiencing severe pain. Conclusions: Transperineal fusion biopsies under local anesthesia result in moderate pain. Pain does not influence clinically significant prostate cancer target detection. Patient anxiety predicts pain. 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Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. The study has been registered and approved by local ethical committees at San Giovanni Battista Hospital, Turin, Italy (local ethical committee approval and registration protocol number 39636) and at Drum Tower Hospital, Nanjing, China (local ethical committee approval and registration protocol number 2019-174-02). All included patients provided written informed consent after being appropriately informed on possible benefits and side effects of the procedure, including pain and complications. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 204, NO. 6, (1113-1114), Online publication date: 1-Dec-2020. Volume 204Issue 6December 2020Page: 1209-1215Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.KeywordspainprostateanxietybiopsyAcknowledgmentsCollaborators were Mattia Beltrami, Stefano Tappero and Daniele D'Agate from the Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy.MetricsAuthor Information Giancarlo Marra Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy Equal study contribution. More articles by this author Junlong Zhuang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China Equal study contribution. More articles by this author Alessandro Marquis Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy †Correspondence: Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Cso Bramante 88/90, 10126Turin, Italy E-mail Address: [email protected] More articles by this author Xiaozhi Zhao Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author Giorgio Calleris Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author Yansheng Kan Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author Marco Oderda Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author Haifeng Huang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author Riccardo Faletti Department of Radiology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author Qing Zhang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author Luca Molinaro Department of Pathology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author Wei Wang Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China More articles by this author Laura Bergamasco Department of Radiology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author Hongqian Guo Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China †Department of Urology, Nanjing Drum Tower Hospital and Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing210008, Jiangsu , People's Republic of China E-mail Address: [email protected] More articles by this author Paolo Gontero Department of Urology, San Giovanni Battista Hospital, AOU Città della Salute e della Scienza and University of Turin, Turin, Italy More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. The study has been registered and approved by local ethical committees at San Giovanni Battista Hospital, Turin, Italy (local ethical committee approval and registration protocol number 39636) and at Drum Tower Hospital, Nanjing, China (local ethical committee approval and registration protocol number 2019-174-02). All included patients provided written informed consent after being appropriately informed on possible benefits and side effects of the procedure, including pain and complications. Advertisement PDF DownloadLoading ...