PROSTATE cancer remains one of the most common urological malignancies worldwide. As diagnosis often involves invasive biopsies, such as transrectal ultrasound (TRUS)-guided biopsies, which can cause significant discomfort and pain, investigations into methods to alleviate discomfort are welcome for patients. A recent study investigated the pain-relieving effects of combining intrarectal local anaesthesia with heated lidocaine gel (ILAHL) with periprostatic nerve block (PNB) (ILAHL + PNB) compared to PNB alone, prior to biopsy.
The prospective randomised trial analysed data from 140 participants who had a TRUS-guided 12-core prostate biopsy from July 2021 to June 2022. Researchers identified participants with suspicious digital rectal examination (DRE) results and/or elevated serum prostate specific antigen (PSA) (≥4.0 ng/mL) and split them into two groups. Both groups received PNB before their biopsies, but the ILAHL group received 20 mL 2% lidocaine gel intrarectally prior to PNB. To observe effects between groups, researchers recorded patient-reported pain scores using visual analogue scale (VAS) from 0 (no pain) to 10 (intolerable pain) at four different points of the biopsy procedure.
The results showed a significant decrease in patient-reported pain in the ILAHL group during the induction of the local anaesthesia (VAS A) (treatment difference –0.92; 95% CI: –0.39––1.45 [p value: 0.001]); during transrectal probe insertion (VAS B) (treatment difference –0.98; 95% CI –0.46––1.51 [p value: <0.001]); and during biopsy punctures (VAS C) (treatment difference −0.87; 95% CI: –0.37––1.36 [p value: 0.001]). However, no significant difference was observed 30 minutes after biopsy (VAS D). Furthermore, no significant difference was seen between groups for post-biopsy complications, including haematuria, rectal bleeding, and haematospermia, indicating a promising method to reduce patient discomfort during TRUS biopsies.
The authors do note some limitations of the study, including limited sample size and recruitment from a single centre. Additionally, they note that no assessments were completed for subanalysis based on prostate volume, age or comorbidities. To remedy this, future research aims to complete a prospective randomized multicentre trial, with a greater number of participants, to verify the results of this study.
Reference
Kim, JI et al. Combination of intrarectal heated lidocaine gel and periprostatic nerve block for pain control during transrectal ultrasound-guided prostate biopsy: A prospective randomized trial. Investig Clin Urol. 2025; DOI: 10.4111/icu.20240312.
