From the Guidelines
Prostate biopsies can be made more tolerable with the use of local anesthesia, such as lidocaine injection into the prostate, which is the standard approach and should be offered to all patients. This is supported by the most recent and highest quality study, which emphasizes the importance of local anesthesia in reducing pain and discomfort associated with prostate biopsy 1.
Pain Management Strategies
Several pain management strategies can be employed to make the procedure more tolerable, including:
- Local anesthesia with lidocaine injection into the prostate, often administered as a periprostatic nerve block
- Oral medications taken 30-60 minutes before the procedure, such as acetaminophen (1000mg) and/or an NSAID like ibuprofen (600mg)
- Antibiotics prescribed before the procedure to prevent infection
- Breathing techniques and relaxation of the pelvic floor muscles to reduce discomfort during the biopsy
Procedure and Aftercare
The procedure itself usually takes only 10-15 minutes, with the actual sampling causing brief sharp pain. Most patients experience soreness for 1-2 days afterward, which can be managed with over-the-counter pain relievers. The discomfort occurs because the prostate is a sensitive organ with many nerve endings, and the biopsy needle causes temporary trauma to the tissue and surrounding nerves.
Recommendations
Local anesthesia should be offered to all patients undergoing prostate biopsy, as it has been shown to decrease pain and discomfort associated with the procedure 1. Additionally, other pain management strategies, such as oral medications and breathing techniques, can be employed to further reduce discomfort. It is also important to note that the use of antibiotics before the procedure can help prevent infection.
Evidence
The evidence supports the use of local anesthesia in reducing pain and discomfort associated with prostate biopsy, with studies showing that up to 90% of men undergoing a prostate biopsy have reported some discomfort during the procedure, and that local anesthesia can greatly enhance the acceptability of the procedure 1. The most recent and highest quality study emphasizes the importance of local anesthesia in reducing pain and discomfort associated with prostate biopsy 1.
From the Research
Pain Management for Prostate Biopsy
- The use of local anesthesia has been shown to be effective in reducing pain during prostate biopsy 2, 3, 4, 5, 6.
- Periprostatic lidocaine injection is a common method used to reduce pain during prostate biopsy, with studies showing a significant reduction in pain levels compared to placebo 2.
- Other methods, such as intraprostatic administration of local anesthesia, have also been shown to be effective in reducing pain during prostate biopsy 4, 6.
- Noninfiltrative anesthesia, such as lidocaine-prilocaine cream and lidocaine-ketorolac gel, has also been shown to be effective in reducing pain during prostate biopsy 3.
Comparison of Anesthesia Methods
- A study comparing periprostatic lidocaine injection and intraprostatic administration of local anesthesia found that intraprostatic administration was more effective in reducing pain during biopsy 4.
- Another study comparing lidocaine-prilocaine cream and lidocaine-ketorolac gel found that lidocaine-prilocaine cream was more effective in relieving probe-related pain, while lidocaine-ketorolac gel was more effective in relieving sampling-related pain 3.
- A study comparing transrectal lidocaine gel and intraprostatic lidocaine injection with intra rectal gel found that the latter method was less painful 6.
Safety and Efficacy
- The use of local anesthesia for prostate biopsy has been shown to be safe and effective, with minimal complications reported 2, 3, 4, 5, 6.
- The visual analogue scale (VAS) has been used to evaluate pain scores in several studies, with results showing a significant reduction in pain levels with the use of local anesthesia 2, 3, 5, 6.