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Risk Factors and Contemporary Management Options for Pain and Discomfort Experienced During a Prostate Biopsy - Beyond the Abstract

Advances in imaging interpretation have led to more accurate risk stratification for men being diagnosed with prostate cancer (PCa). A significant number of men are diagnosed with low-risk prostate cancer and are subsequently followed with active surveillance (AS). An essential part of AS is patient adherence to follow-up protocols, hence optimizing patient experience during follow-up is crucial for compliance and monitoring for progression.

All active surveillance protocols recommend periodic surveillance of prostate biopsies. This review of the current literature reveals several important findings of ways to mitigate patient discomfort during biopsy and provides guidance on how to improve patient compliance with surveillance protocols.

Patients undergoing transrectal biopsies generally reported lower pain scores compared to those undergoing transperineal procedures, largely due to the efficacy of local anesthesia techniques. Furthermore, the application of pre-procedural analgesia significantly improved patient comfort and compliance with variations in the analgesic combinations used. Studies also demonstrated that personalized counseling and expectation management reduced anxiety-related pain, enhancing the overall biopsy experience. Emerging non-invasive imaging techniques, such as multiparametric MRI, have shown promise in accurately identifying clinically significant PCa lesions and thus, reducing the necessity for repeated biopsies. These results highlight the importance of integrating pain management strategies and advanced imaging technologies into routine practice, potentially improving patient adherence and outcomes during AS protocols.

Moreover, to prevent possible loss to follow-ups, previous studies have highlighted a broad spectrum of patient related factors and their association with pain during prostate biopsy.1 In the same manner, mitigation strategies have been explored, especially cost-effective ones such as diaphragmatic breathing, music therapy, and hand holding.2 Nonetheless, literature remains lacking on the effectiveness of these mitigation strategies in reducing pain during prostate biopsy.

This article reviews and extensively discusses previously assessed clinical factors influencing pain or suboptimal experience during a prostate biopsy, along with contemporary management strategies, referencing the most suitable literature. Recognizing these factors can help clinicians provide more robust and comprehensive counseling on biopsy expectations, which has been shown to help patients manage their discomfort.3

Written by: Gabriela M. Diaz,1 Lindsey T. Webb,1 Maximilian J. Rabil,1 Soum D. Lokeshwar,1 Ankur U. Choksi,1 Michael Leapman,1 Preston C. Sprenkle1,2


  1. Department of Urology, Yale School of Medicine, New Haven, CT
  2. Veterans Affairs Connecticut Healthcare System, West Haven, CT
References:

  1. Sonmez G, Tombul ST, Demirtas T, Demirtas A. Risk factors associated with pain in fusion prostate biopsy. Prostate Int. 2020 Dec;8(4):185-189. doi: 10.1016/j.prnil.2020.05.004. Epub 2020 May 29. PMID: 33425797; PMCID: PMC7767937.
  2. Łaszkiewicz J, Krajewski W, Łuczak M, et al. Pain reduction methods during transurethral cystoscopy. Contemporary Oncology/Współczesna Onkologia. 2021;25(2):80-87. doi:10.5114/wo.2021.106652.
  3. Krausewitz P, Schmeller H, Spitzer C, Ellinger J, Ritter M, Petrowski K, Conrad R. Emotion-centered versus fact-centered medical information to alleviate pain and anxiety in prostate biopsy: A randomized trial. Prostate. 2023 Dec 20. doi: 10.1002/pros.24659. Epub ahead of print. PMID: 38116739.
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