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Alleviating Patient Discomfort During a Prostate Cancer Screening

Determining whether or not to undergo a prostate cancer screening is a decision that haunts all men at some point in their lives. While many men cringe at the thought of a prostate cancer screening, the procedure may increase the likelihood of detecting treatable early stage prostate cancer before it becomes metastatic.

Prostate cancer is cancer that grows in the prostate, a small gland found only in men which produces a fluid that helps sustain and transport sperm. While the cause of prostate cancer is unclear, doctors have discovered that the disease begins to form when cells in the prostate gland become abnormal, manifesting lesions or tumors.1

Early detection of prostate cancer depends upon the combined results of two separate tests: an analysis of a patient’s prostate-specific antigen (PSA) levels, which can be measured through a blood test, and a transrectal ultrasound-guided prostate biopsy (TRUSPB), which can only be performed during a screening.2

While medical experts concur that a routine prostate cancer screening is not necessary for all men, patients still shouldn’t dodge prostate screenings since it depends upon the individual patient’s background. Before undergoing a prostate cancer screening, men should consult with their doctors about their individual risk factors and determine if the benefits of screening outweigh the harms. According to Richard Hoffman, a professor of medicine at the University of Iowa, the risk of prostate cancer increases if men have these factors:6

  • Old age: Usually found in men older than 50.
  • Ethnic background: Advances in African-American men more often than white and Hispanic men.
  • Family medical history: Patient with a first-degree relative (father or brother) who has contracted prostate cancer.
  • Poor diet: A diet that’s high in animal fat or low in vegetables.

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To alleviate patient discomfort and receive the most accurate results during a prostate cancer screening, urologists should discuss the procedure in detail with patients and suggest different sedation techniques that are appropriate.6

Understanding what happens during screenings

The first step of coping with procedure-related stress is to understand the basic fundamentals of prostatic cancer imaging and the abnormalities urologists are there to spot.

The procedure first begins with a urologist inserting a transducer, a small handheld imaging probe, through the anus and into the rectum. The doctor will use the transducer to search for abnormal masses or to pinpoint any changes in the appearance, size, or contour of organs, tissues, and vessels.6

Based on the location of the prostate gland (directly above the rectum and below the bladder), an ultrasound exam needs to be administered transrectally. In order to ensure the patient is as comfortable as possible during this process, the transducer will be covered with a disposable protective cover and lubricated with gel beforehand. The process will require the patient to lie on their side with their knees bent to give the transducer greater visibility of the prostate gland. When the transducer is being inserted, patients will feel less discomfort if they are more relaxed.6

In the event that a urologist discovers any abnormalities during the screening, an ultrasound-guided biopsy may be performed with a radiologist present to ensure accuracy. During a TRUS-guided biopsy, a needle is placed into the prostate gland and extracts a tissue sample for testing.6

Learn the statistical likelihood of aggressive prostate cancer

If a doctor recommends a biopsy based on the results of a PSA test or screening, patients shouldn’t automatically jump to unfavorable conclusions. According to a 2018 study in the Saudi Journal of Anesthesia, men who undertake a transrectal ultrasound-guided prostate biopsy often exhibit high levels of psychological stress, which can be attributed to the fear of a cancer diagnosis or to the uncomfortable nature of the screening. For those who are anxious about the findings a screening may uncover, patients can manage their stress level ahead of the procedure by educating themselves about the statistical likelihood of contracting an aggressive prostate cancer.4

According to the American Cancer Society, one man out of nine will be diagnosed with prostate cancer within his lifetime. While prostate cancer is very common in men age 65 or older, most prostate cancer diagnoses are not fatal.7

Dr. Richard Hoffman confirms that “The five-year survival for men who have prostate cancer confined to the prostate gland (early stage) is nearly 100 percent; this drops to 30 percent for men whose cancer has spread to other areas of the body. However, many early-stage cancers are not aggressive, and the five-year survival for those will be nearly 100 percent even without any treatment.” 6

Since most early-stage prostate cancers are not metastatic, it’s important to be diagnosed early so the cancer can be actively monitored or, if necessary, receive treatment before it spreads to other regions of the body. If patients are still anxious about undertaking a screening after learning more of the facts about prostate cancer, it’s beneficial to remember that early detection of prostate cancer through screenings can lead to better outcomes.7

Combined sedation techniques yield less discomfort

According to Dr. Marc B. Garnick, a prostate cancer expert at the Beth Israel Deaconess Medical Center, "Local anesthesia makes a world of difference between having a tolerable biopsy experience and an unpleasant one.” For men who are uncomfortable with the invasive nature of the screening, some doctors recommend different sedation techniques to limit a patient’s pain and discomfort, such as:9

  • Intrarectal lidocaine gel
  • Periprostatic nerve block
  • Inhalation of nitrous oxide

The periprostatic nerve block is recognized as the standard form of anesthesia used to alleviate the pain experienced by patients during a biopsy. While periprostatic nerve block stood out during a study in the Korean Journal of Radiology as one of the most straightforward and cost-effective methods of sedation, recent reports show that periprostatic nerve block is inadequate to limit pain when used by itself.5

Rather than using a single technique on its own, researchers discovered that combining IV sedation and periprostatic nerve block is more efficient at managing and limiting pain. Not only did the combination of sedation techniques enhance a patient’s tolerance, but it also gave biopsy cores a more efficient aim, as well as allowed an increased number of biopsy cores to be implemented when needed without raising distress levels in patients.5

 

References:

  1. Should I be screened? Prostate Cancer Foundation. https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/should-i-be-screened/ Web. May 25, 2019.
  2. James, L., et al. Men’s perspectives of prostate cancer screening: A systematic review of qualitative studies. PLOS. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705146/ Web. May 25, 2019.
  3. How to Collect High Quality Cancer Surveillance Data. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/npcr/pdf/abstracting/prostate.pdf Web. May 25, 2019.
  4. Atta, H., et al. Which is better for pain reduction during transrectal ultrasound-guided biopsy of the prostate: Intravenous diazepam, local periprostatic nerve block, or combination? a controlled randomized study. Saudi Journal of Anaesthesia. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789491/ Web. May 25, 2019.
  5. Nazir, B., Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know. Korean Journal of Radiology. 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170156/ Web. May 25, 2019.
  6. Hoffman, R., Patient education: Prostate cancer screening (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/prostate-cancer-screening-beyond-the-basics Web. May 25, 2019.
  7. Key Statistics for Prostate Cancer. Prostate Cancer Facts. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html Web. May 25, 2019.
  8. Kumar, A., et al. Is periprostatic nerve block a gold standard in case of transrectal ultrasound-guided prostate biopsy? PubMed. 2013. https://www.ncbi.nlm.nih.gov/pubmed/24049376/ Web. May 25, 2019.
  9. How to make your prostate biopsy go better-before, during, and after. Harvard Health Publishing. 2015. https://www.health.harvard.edu/cancer/how-to-make-your-prostate-biopsy-go-better-before-during-and-after Web. May 25, 2019.