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Mitchell Huang, MD, on the link between obesity and pain on transperineal biopsy
Recent data suggest that obesity may be a risk factor for increased pain on transperineal biopsy.
The PREVENT trial (NCT04843566) previously showed that transperineal biopsy was associated with fewer infectious complications than transrectal biopsy. However, patients who underwent transperineal reported higher periprocedural pain (0.6 adjusted difference [0-10 scale]; 95% CI, 0.2 to 0.9).1
Data that were recently presented at the 2025 American Urological Association Annual Meeting in Las Vegas, Nevada suggest that obesity may be a risk factor for increased pain on transperineal biopsy.2 In an interview with Urology Times®, Mitchell M. Huang, MD, discusses these findings in-depth.
“[We found that] when you adjusted for things like prostate size [and] the amount of 1% buffered lidocaine, that obese patients had 8% higher odds of experiencing severe pain, which we defined as a score of 7 out of 10, and also at 10% higher odds of having severe discomfort,” he reported.
Huang is a PGY-4 resident at Northwestern University in Chicago, Illinois.
According to Huang, there are a few different hypotheses for these findings. The first, he says, may be attributed to the position of the patient. Transperineal biopsy is now being conducted while patients are awake and in stirrups, which may contribute to discomfort. Another theory is that the pain may be due to the fact that there is more tissue to navigate when inserting the needle through the perineum in larger patients.
This study may inform interventions to make patients more comfortable during the procedure, Huang noted.
REFERENCES
1. Hu JC, Assel M, Allaf ME, et al. Transperineal versus transrectal magnetic resonance imaging-targeted and systematic prostate biopsy to prevent infectious complications: The PREVENT randomized trial. Eur Urol. 2024;86(1):61-68. doi:10.1016/j.eururo.2023.12.015
2. Huang MM, Handa N, Driscoll CB, Hu JC, Schaeffer EM. Obesity is associated with severe pain and discomfort on transperineal prostate biopsy: A secondary analysis of the PREVENT trial. J Urol. 2025;213(5S):e216. doi:10.1097/01.JU.0001109780.20015.87.17
