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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 484-485
Prostate biopsy and what men should be told about the procedure

1 Royal Liverpool University Hospital, Prescott Street, Liverpool and Arrowe Park Hospital, Upton, Merseyside, United Kingdom
2 University of Port Harcourt Teaching Hospital, Nigeria

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How to cite this article:
Eke U, Eke F. Prostate biopsy and what men should be told about the procedure. Saudi J Kidney Dis Transpl 2009;20:484-5

How to cite this URL:
Eke U, Eke F. Prostate biopsy and what men should be told about the procedure. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 26];20:484-5. Available from: https://www.sjkdt.org/text.asp?2009/20/3/484/50788
To the Editor,

Prostate cancer (PC) is the leading cause of male cancer death, particularly after the age of 50years. [1]

Clinical features of locally invasive disease and BPH are similar and the final diagnosis of PC is anchored on tissue histology, obtained by the gold standard Transrectal ultrasound guided biopsy (TRUSBX). [2]

Frequently reported complications following TRUSBX include hematuria, rectal bleeding, urinary tract infection, acute urinary retention and uncommon complications are bacteremia, septicemia, septic shock and death. [3]

Like any invasive procedure informed consent and understanding of the patient for the need of the biopsy as well as its complications is essen­tial for proper management. [4] We therefore stu­died patients and relevant staff involved with TRUSBX at the Royal Liverpool University Hospital (RLUH).

A questionnaire for the patients was adminis­tered by personal interview, to assess patients' satisfaction with preoperative information and tolerance of the procedure. Another question­nnaire was designed simultaneously to deter­mine the attitude of doctors including the infor­mation they gave to the patients regarding the procedure including: technique used in the pro­cedure; pain; rectal bleeding; urinary tract in­fection; hematuria; hematospermia; septicemia; urine retention; constipation and antibiotic pro­phylaxis. The interviews were done ten minutes after the procedure except in one patient who was interviewed 2 weeks after the procedure.

TRUSBX was done in the left lateral decu­bitus position without analgesia and under ultra­sound guidance multiple biopsies were obtained transrectally.

After observation for an hour and exclusion of urinary retention patient is discharged with oral antibiotics for 5-7 days.

Independent variables were Likert scale ra­tings. [5] Patients were asked to score pain using a score of 1 (very little) to 5 (very severe). Patients rated the information they were given 1 (poor) to 5 (excellent).

Total, twelve patients aged 50 to 80 years were interviewed. The TRUSBX was uneventful in all. Majority of the patients felt a local anesthe­sia could have been better (n= 7, 58.3%) how­ever pain scoringfrom mild, modertate and se­vere was not much different [Table 1].

Three patients (25%) gave a score of 5/5 for pain afterwards, [Table 1]. Five (41.6%) reported the procedure as uncomfortable but not painful. Seven (58.3%) mentioned that in their opinion they might have benefited from local anesthesia. All patients had received an information leaflet with a checklist for things to avoid or do after prostatic biopsy (PBX). Six patients (41.6%) had the procedure explained by the doctor and majority felt that the doctor should have ex­plained the procedure, however more than 80% felt that the information provided by the doctor or the nurse was complete enough.

Ten medical (8 physicians and 2 nurses) in­volved in the procedure were interviewed. In general they had discussed about the ma-jor complications with almost all patients, except possibility of repeat biopsy that was discussed by only three (30%) persons. Still two (17%) patients had no clue about the procedure.

In this survey, TRUSBX was well tolerated by all the patients and uneventful within 1hour of the procedure in this study similar to previous reports. [6] Five patients (41.6%) experienced pain and severe discomfort and would have pre­ferred anaesthesia during the procedure as sup­ported by recent study of Crundwell et al. [7] Re­cent studies recommend the use of local anes­thesia, preferably injectable local anesthesia. [8]

Since anxiety has significant effect on the fee­ling of pain, detailed information by the physi­cian prior to the procedure would alleviate the anxiety and thus decrease the pain. Repeat biopsy is possible with any procedure and should be discussed prior to the procedure. In this survey only 3 physicians discussed the possible need for further samples.

Since our study had small number of patients, a multi centre study is needed to assess the patients' perspective and improve the patients comfort and understanding of TRUSPB.

In conclusion, TRUSBX remains the most co­mmon and favourable method of obtaining prostate tissue for definite diagnosis of PC. Adequate information about the procedure will help in reducing anxiety and discomfort as well as ensure compliance and maintain an efficient patient-doctor relationship.

   References Top

1.Halabi S, Vogelzang NJ, Ou SS, et al. Clinical outcomes by age in men with hormone refractory prostate cancer: a pooled analysis of 8 Cancer and Leukemia Group B (CALGB) studies. J Urol 2006;176:81-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Presti JC Jr, O'Dowd GJ, Miller MC, et al. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates; results of a community multipractice study. J Urol 2003;169:125-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Sieber PR, Rommel FM, Theodoran CG, et al. Contemporary prostate biopsy complication rates in community-based urology practice. Urology 2007; 70:498-500.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Snow SL, Panton RL, Butler LJ, et al. Incomplete and inconsistent information provided to men making decisions for treatment of early-stage prostate cancer. Urology 2007;69:941-5.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Sisson SD, Boonyasai R, Baker-Genaw K, et al. Continuity Clinic Satisfaction and Valuation in Residency Training. J Gen Intern Med 2007;22: 1704-10.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Enlund AL, Varenhorst E. Morbidity of ultrasound­guided transrectal core biopsy of the prostate without prophylactic antibiotic therapy. A prospective study in 415 cases. Br J Urol 1997;79:777-80.  Back to cited text no. 6    
7.Crundwell MC, Cooke PW, Wallace DM. Patients' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases. BJU Int 1999;83 :792-5.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Inal G, Adsan O, Ugurlu O, et al. Comparison of four different anesthesia methods for relief of all pain during transrectal ultrasound-guided prostate biopsy. Int Urol Nephrol 2007; (Epub ahead of print).  Back to cited text no. 8    

Correspondence Address:
Felicia Eke
University of Port Harcourt Teaching Hospital
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PMID: 19414960

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