title: Comparison of patient comfort between MR-guided in-bore and MRI/ultrasound fusion-guided prostate biopsies within a prospective randomized trial.
abstract: OBJECTIVE
  The objective of this study was to compare patient comfort between MR-guided in-bore prostate biopsy (IB-GB) and MRI/ultrasound fusion-guided prostate biopsy (FUS-GB) with additional systematic 12-core transrectal ultrasound (TRUS)-guided biopsy within a prospective randomized trial.
  
  
  METHODS
  Two hundred and ten consecutive patients were randomly assigned in a 1:1 ratio to receive either IB-GB and prior intrarectal instillation of a 2% lidocaine gel (n = 106) or FUS-GB plus additional systematic 12-core TRUS-guided biopsy and prior application of a periprostatic nerve block (PPNB) with 2% mepivacaine (n = 104). The maximal procedural pain (MPP) on a 0-10 visual analog scale and the operating room time were recorded for each biopsy session.
  
  
  RESULTS
  Baseline characteristics and mean number of targeted biopsy cores (5.6 ± 0.8 vs 5.4 ± 1.2 for IB-GB and FUS-GB, respectively; p = 0.278) were similar in both study arms. In relation to the IB-GB arm, the total number of biopsy cores in the FUS-GB arm, including the systematic 12-core TRUS-guided biopsy, was significantly higher (17.4 ± 1.2; p < 0.001). Patients with IB-GB had significantly higher MPP scores (2.95 ± 2.15) compared with subjects with FUS-GB (1.95 ± 1.56; p < 0.001). FUS-GB required significantly less time (28.22 ± 11.61 min) in comparison with IB-GB (42.09 ± 11.37 min; p < 0.001).
  
  
  CONCLUSIONS
  The PPNB can easily be administered just prior to performing FUS-GB. Thus, patients have significantly lower pain levels in comparison with IB-GB, which is usually done with intrarectal anesthetic gels. Although the addition of a systematic 12-core TRUS-guided biopsy significantly increases the number of biopsy cores, FUS-GB still requires significantly less time in comparison with IB-GB.
authors.affiliation: Department of Urology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. christian.arsov@med.uni-duesseldorf.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Arsov
authors.affiliation: Department of Urology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Robert.Rabenalt@med.uni-duesseldorf.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Rabenalt
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Michael.Quentin@med.uni-duesseldorf.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Quentin
authors.affiliation: Department of Urology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Andreas.Hiester@med.uni-duesseldorf.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hiester
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Dirk.Blondin@sk-mg.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Blondin
authors.affiliation: Department of Urology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. urologie@uni-duesseldorf.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Antoch@med.uni-duesseldorf.de.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Lars.Schimmoeller@med.uni-duesseldorf.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Schimmöller
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012007:Rectum; D013997:Time Factors
keywords: MR-guided in-bore prostate biopsy; MRI/ultrasound fusion-guided prostate biopsy; Patient comfort; Periprostatic nerve block; Prostate cancer