Pain Perception During Transperineal and Transrectal Prostate Biopsy Under Local An-esthesia: a Prospective Analysis of a Multi-ethnic and Diverse Cohort

Abstract

Purpose: To assess factors associated with patients' self-assessed pain scores during prostate biopsy (PBx) performed exclusively under local anesthesia (LA).

Materials and methods: Consecutive patients who underwent MRI followed by a transperineal (TP) or transrectal (TR) PBx under LA were prospectively assessed. Race and ethnicity were self-reported according to NIH standards. Socioeconomic status was assessed using the Distressed Community Index (DCI). Pain was evaluated with a visual analog scale (0-10) after the procedure. Univariable and multivariable linear regression analyses were performed to correlate clinical parameters related to pain.

Results: A total of 419 patients underwent TP (77%) or TR (23%) PBx. Overall, 14% of patients were Asian, 5% Black, 17% Latino, 12% Others, and 53% White. Of the cohort, 20% of Black and 27% of Latino patients were most distressed (DCI 80-100) compared with 4% of Asian, 9% of Other, and 5% of White patients (p<0.001). The median (IQR) self-assessed pain levels were higher for Black 5 (2-5) and Latino 4 (3-5) compared to Asian 3 (2-4), Other 3 (2-5), and White 3 (2-4) patients (p=0.01). On multivariable analysis, younger patients, Black or Latino patients, and the number of lesions on MRI were independent predictors for pain levels.

Conclusions: PBx under LA alone are generally well tolerated; however, there is a subset of patients who experience more pain, including Black and Latino, younger patients, and those with more MRI suspicious lesions. Discussion of these pain risk factors is important for patients when choosing to have a biopsy performed under LA versus sedation.

Chua KJ, Ramacciotti LS, Kaneko M, Inoue Y, Navarro LM, Cai J, Aron M, Halteh P, Kau E, Schuckman A, Hemal S, Desai M, Djaladat H, Gill IS, Aron M, Abreu AL. Pain Perception During Transperineal and Transrectal Prostate Biopsy Under Local An-esthesia: a Prospective Analysis of a Multi-ethnic and Diverse Cohort. Int Braz J Urol. 2026 May-Jun;52(3):e20250512. doi: 10.1590/S1677-5538.IBJU.2025.0512. PMID: 41678707.