Introduction: Transrectal (TR-Bx) and transperineal (TP-Bx) prostate biopsy have been extensively compared in terms of cancer detection rates and complication rates. While these factors can influence a urologists’ method of biopsy, comparative data on patients' preference based on their experience is lacking. The aim of our study was to identify patient-reported preferences for various aspects of TR-Bx and TP-Bx procedures.
Methods: We queried our prospective prostate database to identify patients who had undergone both, TR-Bx and TP-Bx, procedures in the office using local anesthesia (LA) alone. We surveyed the patients regarding their preference for TR-Bx and TP-Bx at various steps of the procedure such as pre-biopsy preparation, position (lithotomy vs left lateral) during biopsy, and LA injection. Patients were contacted over the telephone and asked the same set of questions in a standardized format. A chi-squared test was performed with a p < 0.05 considered significant.
Results: A total of 49 patients, who had undergone both biopsy procedures, responded to the phone survey. All patients underwent an office-based TP-Bx after having undergone TR-Bx using LA alone, with a median interval between procedures of 29.5 months. Patient preferences are detailed in the Table. Significantly more patients preferred the TP-Bx prep, but more patients preferred the position for TR-Bx. Significantly higher preference was noted for TR-Bx during LA infiltration, likely due to the position of increased pain with LA injection during TP-Bx. Over 25% of patients would rather be under general anesthesia (GA) for TP-Bx (10.2%), TR-Bx (4.1%) or both (12.2%) (p < 0.001), and 16.3% would be willing to pay $100-$500 out-of-pocket for it. If they required a repeat biopsy in the future, 61% would prefer TP-Bx and 32.7% would choose TR-Bx (p <.0001).
Conclusions: Patient preference for different steps of the procedure was variable between TR-Bx and TP-Bx. Patients would prefer TP-Bx over TR-Bx in the future with nearly 2:1 ratio. One-fourth would prefer GA over LA, and one-fifth will be willing to accept the out of pocket cost. This patient-reported data identifies opportunities to improve the patient experience at various steps of prostate biopsy procedures.
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