Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores

• Published in: The Journal of urology Vol. 163; no. 1; p. 168
• Main Authors: Naughton, C K, Ornstein, D K, Smith, D S, Catalona, W J
• Format: Journal Article
• Language: English
• Published: United States 01-01-2000
• Subjects: Aged; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; Biopsy, Needle - statistics & numerical data; Humans; Male; Middle Aged; Pain, Postoperative - epidemiology; Pain, Postoperative - etiology; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Rectum; Surveys and Questionnaires; Ultrasonography
• ISSN: 0022-5347
• DOI: 10.1016/S0022-5347(05)67996-7

An increasing number of studies suggest that 6-sector transrectal ultrasound guided biopsy of the prostate provides insufficient material to detect all clinically important prostate cancers and more cores may improve detection rates. We performed a prospective, randomized study to determine the effect of increasing the number of cores from 6 to 12 on pain and other morbidity associated with the biopsy procedure.
A total of 160 men (44 black, 28%) with a mean age plus or minus standard deviation of 65+/-8 years who had serum prostate specific antigen between 2.5 and 20.0 ng./ml. and/or digital rectal examination findings suspicious for cancer were prospectively randomized to undergo 6 or 12-core biopsy. Patients completed a self-administered questionnaire addressing pain and other morbidity before, and immediately and 2 and 4 weeks after biopsy.
There was no difference between groups in mean pain scale with time for abdominal and rectal pain. For probe insertion, needle insertion and overall pain there was a significant increase in pain recalled at 2 which persisted at 4 weeks compared to immediately after biopsy. However, there was no difference for these 3 post-biopsy pain measures between the 6 and 12-core groups. In the 12-core group there was a statistically significant increase in hematochezia and hematospermia (24% versus 10%, p = 0.04 and 89% versus 71%, p = 0.01, respectively) but no significant difference between groups reporting morbidity as a moderate or major problem. There was no significant change in International Prostate Symptom Score, fever or hospitalization in the 12-core group.
The 12-core prostate biopsy procedure is generally well tolerated and can be safely performed with no significant difference in pain or morbidity compared to the 6-core procedure.