ANZ J. Surg. 2005; 75: 662–664 ORIGINAL ARTICLE MEASURING MEN’S OPINIONS OF PROSTATE NEEDLE BIOPSY JESSICA C. C. MEDD,* MARTIN R. STOCKLER,† RUTH COLLINS‡ AND ANDRE LALAK‡ *Concord Prostate Centre, Concord Hospital, †Sydney Cancer Centre – Royal Prince Alfred and Concord Hospitals and NHMRC Clinical Trials Centre, University of Sydney, and ‡Urology Department, Concord Hospital, Sydney, New South Wales, Australia Background: Needle biopsy of the prostate is an important, common, invasive procedure. Little is known about men’s perceptions of it. The present study was designed to assess men’s experience of prostate biopsy, to determine the feasibility of a randomized trial of interventions to alleviate distress during prostate biopsy, and to develop a pragmatic outcome measure for such a trial. Methods: Of 33 consecutive men undergoing prostate biopsy at a Sydney (Australia), tertiary referral urology centre 31 men were selected for study. A cross-sectional, observational was performed. Participants completed both a 24-item questionnaire assessing relevant symptoms, attitudes and emotional responses and a semistructured interview shortly after their prostate biopsy. Each item of the questionnaire was rated on an 11-point scale from 0 (no trouble at all), to 10 (worst they could imagine). Results: The mean score for discomfort was 4.4 with 32% scoring ≥ 7; the mean score for pain was 4.2 with 29% scoring ≥ 7. The other most troubling aspects were: ‘waiting for the result’ (mean 4.4, 32% ≥ 7) and ‘fear of the result’ (mean 3.7, 32% ≥ 7). Seventy- one per cent of subjects stated that they would have been willing to participate in a randomized trial of interventions to make prostate biopsies less unpleasant. Thirteen of the 24 items were retained and refined for use as an outcome measure for subsequent trials. Conclusions: Many men experience pain, discomfort and anxiety during prostate needle biopsy and most would be willing to participate in trials of interventions to make it less unpleasant. Key words: anxiety, pain, prostate biopsy, questionnaire. Abbreviations: TRUS, transrectal, ultrasound-guided. INTRODUCTION Needle biopsy of the prostate is an important, common, invasive procedure. Prostate cancer is the most common cancer and second most common cause of cancer death in Australian men with over 10 000 new cases diagnosed each year, most by means of a prostate needle biopsy. 1 Many more men have prostate biop- sies that are negative. Although controversy persists about the feasibility and benefits of prostate cancer screening, many men who undergo prostate biopsy are asymptomatic. If screening becomes more widely accepted, then the number of men under- going prostate biopsy will rise even further. Repeat biopsies are needed if the results are equivocal, and some men have multiple biopsies over several years., Transrectal, ultrasound-guided (TRUS) needle biopsy of the prostate is the gold standard test for diagnosing prostate cancer. It requires the insertion of an ultra- sound probe into the rectum and 6–12 passes through the rectal wall into the prostate with an 18-G biopsy gun. There is surprisingly little information about men’s experi- ences and perceptions of prostate biopsies; and most of what there is comes from studies assessing interventions. Of the studies that have questioned men following prostate biopsy, pain has been reported in up to 96% of subjects 2 with severe pain in around 20%. 2,3 The majority of patients have also reported dis- comfort and embarrassment. Anxiety before prostate biopsy has been correlated with worse pain reported during the biopsy. 2 Anxiety levels were highest prior to disclosure of biopsy result. Use of local anaesthetic in the periprostatic tissues has been asso- ciated with less pain during prostatic biopsy in some studies 4–8 but not others. 9,10 We could not find formal data about the use of anaesthesia or analgesia for prostate biopsy in Australia, but informal surveys of Australian urologists suggest considerable heterogeneity of practice. The purpose of the present study was to describe men’s experi- ences of prostate biopsy and their willingness to participate in trials of interventions to make it less unpleasant. We also sought to develop and refine a simple questionnaire that could be used as an outcome measure in such a trial. METHODS Consecutive men referred to the TRUS-Biopsy Clinic of the Department of Urology at the Concord Repatriation General Hos- pital, Sydney, Australia during September and October 2001 were approached about the study. Thirty-one of 33 agreed to par- ticipate: two declined because they were unwilling to complete the questionnaire because of time constraints. The study was approved by the hospital’s human research ethics committee and all men gave written, informed consent. All prostate biopsies were carried out by a single operator (AL), with patients lying on their left side. A 7.5 MHz, multi- plane ultrasound probe was inserted into the rectum after lubrica- tion with 2% lignocaine jelly. Eight biopsies were taken using a Biopty gun (Bard Australia, Sydney, Australia) with an 18-G biopsy needle. Subjects completed a self-administered question- naire and a brief semistructured interview a few minutes after their procedure. J. C. C. Medd BA (Hons), M Psych (Clinical); M. R. Stockler MB BS, MSc (Clin Epi), FRACP; R. Collins BM BS, FRCS (Urol), FRACS, MD; A. Lalak MB BS, FRACS, FRCS (Ed). Correspondence: Dr Martin R. Stockler, Sydney Cancer Centre GH6, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email: stockler@med.usyd.edu.au Accepted for publication 12 March 2005.