Acceptance of repeat transrectal ultrasonography guided prostate biopsies with local anaesthesia.

Objective: • To measure patient discomfort associated with transrectal ultrasonography guided prostate biopsy (TRUSPB) performed with periprostatic local anaesthetic (LA) infiltration and to document agreement to possible repeat biopsy, as a recent audit showed that 86% of Australian urologists performed prostate biopsies using sedation or general anaesthesia (GA), which implies many urologists think patients are unwilling to tolerate the procedure under LA block and/or may refuse a repeat procedure.

Patients And Methods: • This was a prospective cohort study following all men undergoing TRUSPB in 2008. • Immediately after the procedure the men were asked to complete a visual analogue pain score. • They were then asked whether, if it was necessary to have a repeat biopsy, they would agree to LA again or request GA/sedation.

Results: • In all, 476 men participated in the study with a mean age of 64 years. • Of these, 464 men (97.5%) tolerated the procedure well and would, if required, agree to repeat biopsy with LA. • Only 12 men (2.5%) indicated they would request GA/sedation if a repeat biopsy was necessary.

Conclusion: • The vast majority of men accepted having prostate biopsy with LA infiltration and therefore this should be the first method offered. • It may be possible to screen for men who would not tolerate biopsy under LA. • Resource saving by performing most biopsies under LA can be estimated to be >A$10 million annually.