Can General Anesthesia Facilitate the Detection of Clinically Significant Prostate Cancer in Prostate Fusion Biopsy?

Abstract

Background. Although the use of anesthetics in prostate biopsy on pain has been well studied, its effect on the diagnosis of clinically significant prostate cancer (csCPa) is not well known. We aimed to investigate the contribution of performing the prostate fusion biopsy (PFB) procedure under general anesthesia (GA) to diagnosing csCPa. Materials and Methods. We retrospectively analyzed the data of 252 patients who underwent multiparametric magnetic resonance imaging (MpMRI)—guided PFB. Patients were divided into two groups: those under local anesthesia (LA) and GA. For LA and GA groups, csCPa capture rates in PFB were evaluated separately and in total for Prostate Imaging Reporting and Data System (PIRADS) 3, PIRADS 4, and PIRADS 5 lesions. It was investigated whether the PFB application under GA increases the chance of csCPa capture. Chi-square and z-ratio analysis was performed to determine the change in pathological diagnosis according to the anesthesia method. Results. A total of 411 lesions were detected by MpMRI in 252 men included in the study. LA was applied to 61.5% and GA to 38.5% of the patients. We found that the type of anesthesia affected the frequency of csCPa detection only for anterior lesions. Clinically insignificant prostate cancer (CIPC) was detected more frequently in the GA group than in the LA group. Considering PIRADS 3, PIRADS 4, and all lesion groups, benign pathology was statistically significantly more frequent in the LA group, while CIPC was statistically significantly more frequent in the GA group (p  = 0.000). Conclusion. Our study showed that performing PFB under GA may contribute to the diagnosis of csCPa in anterior region lesions. However, this effect could not be demonstrated when all lesions were examined. In fact, it causes more CIPCs to be caught. Considering that the CIPC approach is contradictory in the literature; multicenter, prospective studies with large participation are needed, taking into account patient and lesion characteristics.