Local Anesthesia for Prostate Biopsy

Title: Local anesthesia for office biopsy of the prostate: effects on pain control, quality of life and surgical intervention. Introduction: Local anesthetic should be administered prior to transrectal needle biopsy of the prostate to control pain in the office setting. Various centers have injected anesthetic in different regions in and around the prostate prior to biopsy. Patient experience with each technique has varied. We would like to determine which procedure provides the best pain control. In addition, we would like to know if the anesthetic placement has any effect on urinary patterns, bowel habits, and sexual function. Furthermore, for those patients found to have cancer and elect surgical treatment, we plan to evaluate if the anesthetic had an impact on surgical dissection of their prostate. Methods: The investigators plan to identify those patients who require prostate biopsy for diagnosis. Each patient will be randomly assigned to a different anesthetic injection group. During the biopsy protocol, our nurse will monitor the patient?s pain level according to the visual analog score. The patient will complete a pre-biopsy questionnaire and two post-biopsy questionnaires administered at 1 and 4 weeks after biopsy. He will receive results of the prostate biopsy pathology report within 48 hours by calling his primary referral service.

Sex

Male

Minimum age

18 Years

Maximum age

90 Years

Our study will not exclude patients based on age or race. Any male patient seen in our clinic with the following conditions that warrant and consent to transrectal needle biopsy of the prostate would be recruited for this study:

1. Elevated serum PSA
2. Hypoechoic nodule incidentally discovered on transrectal ultrasound for other purposes
3. Abnormal digital rectal exam (DRE)

The following exclusion criteria must be in place to prevent complications and interference with data interpretation:

1. Patients taking narcotics on a routine basis
2. Patients on Coumadin therapy
3. Patients with ano-rectal disease
4. Patients with history of prostatitis, pelvic pain, pelvic floor tension myalgia, or other pain syndromes
5. Patients with active prostate abscess or urinary tract infection
6. Patients with allergy to local anesthetic

• DERIVEDAshley RA, Inman BA, Routh JC, Krambeck AE, Siddiqui SA, Mynderse LA, Gettman MT, Blute ML. Preventing pain during office biopsy of the prostate: a single center, prospective, double-blind, 3-arm, parallel group, randomized clinical trial. Cancer. 2007 Oct 15;110(8):1708-14. doi: 10.1002/cncr.22973. PMID 17724727