Intraprostatic Anesthesia During Transperineal Prostate Biopsy

Transperineal prostate biopsy has become the standard method for diagnosing prostate cancer because of its favorable safety profile and low infectious complication rates. However, pain and discomfort during the procedure remain important concerns that may negatively affect patient satisfaction and willingness to undergo repeat biopsy when necessary. This prospective randomized controlled study aims to evaluate whether the addition of intraprostatic local anesthesia to standard perineal local anesthesia reduces pain during transperineal prostate biopsy. Fifty patients undergoing prostate biopsy under local anesthesia will be randomized into two groups. The first group will receive standard perineal local anesthesia, while the second group will receive additional intraprostatic local anesthesia. Pain severity will be assessed before, during, and after the procedure using a visual analog scale (VAS). Anxiety and depression levels will be evaluated preoperatively using the Hospital Anxiety and Depression Scale (HADS). Patient-related factors, procedural characteristics, and post-procedural outcomes will also be recorded to identify factors associated with pain perception. The results of this study may help optimize local anesthesia techniques and improve patient comfort during transperineal prostate biopsy.

Inclusion Criteria: * Male patients aged 18 years or older * Clinical indication for transperineal prostate biopsy based on elevated prostate-specific antigen (PSA) level and/or suspicious digital rectal examination findings * Ability to understand and complete the Hospital Anxiety and Depression Scale (HADS) * Ability to provide pain scores using a 10-point Visual Analog Scale (VAS) * Provision of written informed consent Exclusion Criteria: * Previous history of prostate biopsy * Known hypersensitivity or contraindication to local anesthetic agents * Hematological disorders affecting coagulation * Active urinary tract infection * Neurological disorders that may affect pain perception * Psychiatric disorders that may affect pain assessment or completion of study -questionnaires * Inability to complete the HADS questionnaire or VAS assessment * Refusal to participate or inability to provide informed consent