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AUA 2020

AUA 2020: Patient Experience for Transperineal Biopsy Under Local Anesthesia Versus Transrectal Biopsy: Results from the Michigan Urological Surgery Improvement Collaborative

(UroToday.com) For the past three decades or more, transrectal ultrasound-guided biopsy has been considered the standard diagnostic approach for the detection of prostate cancer. In the past few years, driven in large part by concerns regarding post-biopsy sepsis in patients undergoing TRUS procedures, transperineal biopsy has been increasingly utilized with equivalent cancer detection rate compared to TRUS biopsy, however patient experience remains unknown. In a moderated poster presentation at the American Urologic Association Virtual Annual Meeting, Stephanie Ferrante and colleagues presented results of their study assessing the patient experience with in-office transperineal biopsy under local anesthesia within the Michigan Urological Surgery Improvement Collaborative (MUSIC).


To briefly summarize, MUSIC is a physician-led quality improvement consortium comprised of 90% of urologists in Michigan. Between March 2019 and October 2019, patients undergoing transperineal prostate biopsy at 4 MUSIC sites completed a survey assessing overall pain, pain during specific portions of the procedure, and willingness to undergo a repeat procedure if medically necessary. Experience was assessed using a validated visual analog pain scale (VAS). Identical surveys were given to a control group of patients undergoing transrectal biopsy at a single site. Univariate analysis was used to compare responses between the groups.

During the study period, the authors identified 190 patients who underwent transperineal biopsy and completed the surveys as well as 150 patients who underwent TRUS biopsy. The mean VAS rating for overall experience was significantly higher for transperineal biopsy (3.74 vs 3.03, p=0.01) [Figure 1]. This was predominantly driven by greater discomfort during local anesthetic administration (3.77 vs 2.35, p<0.001) and positioning (0.99 vs 0.59, p=0.01) during transperineal biopsy.

AUA2020__transperineal_biopsy.png

The authors did not demonstrate significant variation in VAS scores across sites or providers within the highest volume site.

For patients undergoing transperineal biopsy, discomfort was greatest at the time of probe insertion (mean VAS 2.86).

There was no significant difference between the groups with respect to probe insertion, prostate sampling, or willingness to undergo a repeat procedure.

Presented by: Stephanie Ferrante, Prostate Project Manager, Michigan Medicine, Ann Arbor, MI

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center Contact: @WallisCJD on Twitter at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020