title: A prospective study analysing the effect of pain on probe insertion, and the biopsy strategy, on the patients' perception of pain during TRUS-guided biopsy of the prostate.
abstract: OBJECTIVE
  PSA testing has led to an increasing number of TRUS-guided biopsies being performed. These are well tolerated in the majority, but a minority of men find the procedure unacceptably painful. We have studied a cohort of men undergoing TRUS guided prostate biopsy to ascertain whether the biopsy strategy, or pain on probe insertion, can assist in predicting those who men most likely to suffer severe pain during prostate biopsy.
  
  
  METHODS
  162 men (screened and symptomatic) between 47 and 86 years of age (mean age 61.7 yrs) who attended for TRUS and biopsy were studied. The number of cores taken were governed by TRUS volume, less than and equal to <or=30cc = 6 cores, 30.1-39.9cc = 7-11 cores and greater than and equal to >or=40cc =12 cores. Each completed a 10-point visual analogue pain score (VAS) immediately after procedure. All men were asked to describe their pain, on insertion of the TRUS probe, followed by the first and the last biopsy. All biopsies were taken with an 18G spring-loaded Tru-cut disposable needle. Severe pain (score of 8-10) was deemed unacceptable.
  
  
  RESULTS
  22% (36/162) of the men biopsied experienced unacceptable pain in one or more of the three categories. There was a higher incidence of severe pain in those undergoing 12 cores compared to 7-11, or a standard sextant strategy (p=0.05, Chi-squared for linear trend). Severe pain was experienced by 6% (9/162) of men during probe insertion. Of this group 78% (7/9) also went on to find biopsies unacceptably painful, compared to 19% (29/152) of those who did not experience severe pain for probe insertion (p<0.0001, exact test for two independent proportions).
  
  
  CONCLUSIONS
  Approximately 1 in 5 men experience unacceptable pain at some time during TRUS biopsy of the prostate. A high proportion of men (78%) in whom insertion of the TRUS probe was unacceptably painful, found subsequent biopsies equally painful. With trend towards saturation biopsies the need for predicting group of men who will need local/general anaesthesia is ever-increasing.
authors.affiliation: Palmerston North Hospital, Palmerston North, New Zealand. doctor_chopra@yahoo.com
authors.forename: Samarth
authors.initials: S
authors.lastname: Chopra
authors.forename: Edward W J
authors.initials: EW
authors.lastname: Rowe
authors.forename: Marc
authors.initials: M
authors.lastname: Laniado
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects