Background: Most patients with low risk for prostate cancer should go on active surveillance (AS). However, due to reported patient barriers such as discomfort and inconvenience associated with multiple biopsies, AS rates remain highly variable. This study was conducted to see whether switching to prostate biopsies under anesthesia in 2019 increased adherence with active surveillance.

Methods: A retrospective chart review of our database was conducted to compare patients who underwent prostate biopsy in 2019, the year our institution switched to doing prostate biopsy under a combination of deep sedation and local anesthesia, against a randomized control group of patients who underwent prostate biopsy before this switch.

Results: 469 patients were included in the study, with 230 patients in the control group and 239 patients in the anesthesia group. There were no statistically significant differences between the two groups across age, race, median PSA level at index biopsy, and positive family history. However, the control group was significantly more likely to have had a previous prostate cancer diagnosis (p = 0.03). Median biopsy cores were significantly increased in the group with anesthesia (p < 0.0001). Importantly, the study cohort as a whole was primarily African-American. No statistically significant relationship was seen between anesthesia and completion of confirmatory biopsy, with a similar percentage of groups undergoing active surveillance. Logistic regression analyses showed that anesthesia use was significantly associated with increased likelihood of finding cancer at the time of biopsy in men without a previous prostate cancer diagnosis (O.R.: 1.93 [1.22, 3.03]).

Conclusion: Anesthesia did not impact adherence with AS, with a high percentage in both groups electing for AS and completing confirmatory biopsy. Patients who underwent anesthesia were more likely to be diagnosed with cancer which could be due to increased cognitive fusion or enhanced biopsy performance under anesthesia. These relationships need to be investigated further.

References and Resources

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2. Cricco-Lizza E, Wilcox Vanden Berg RN, Laviana A, Pantuck M, Basourakos SP, Salami SS, Hung AJ, Margolis DJ, Hu JC, McClure TD. Comparative Effectiveness and Tolerability of Transperineal MRI-Targeted Prostate Biopsy under Local versus Sedation. Urology. 2021 Sep;155:33-38.
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