Prostate Biopsy: The Patient-Friendly Position

There are multiple approaches to performing a prostate biopsy, with differing opinions on the effectiveness of each. The most popular method is the transrectal (TR) biopsy, while the more innovative and safer approach is the transperineal biopsy. These procedures can be done under either local or general anesthesia depending on clinical preference and patient needs. In an effort to further improve patient comfort during what can be an uncomfortable experience, some physicians are exploring alternative methods and positioning strategies.

In this article, we take a closer look at one such approach (known as the “patient-friendly position”) with insights from UK-based urologist Dr. Simon Bott at Frimley Park Hospital.

What is the Patient-Friendly Position?

Dr. Bott advocates for performing the biopsy with the patient in a lateral position (lying on the left side), rather than the traditional lithotomy position. This approach improves patient comfort by limiting visual exposure to the biopsy needle, device, and operating room setup. In fact, studies suggest that patients who see the biopsy equipment beforehand report experiencing more pain than those who do not.

Beyond the psychological benefits, the lateral position is also physically more comfortable. It doesn’t require the patient’s legs to be elevated, which may seem minor but plays a meaningful role in helping the patient relax during the procedure.

3 Reasons to Use the Patient-Friendly Position

Now that you understand the patient-friendly position, it’s time to learn why more urologists are considering switching to this alternative approach:

1. Reduced Patient Stress
As we mentioned, positioning the patient on their side limits their view of surgical equipment and surroundings. This simple adjustment significantly reduces anxiety and helps the patient stay calm and relaxed throughout the procedure. A relaxed patient also creates a better working environment for the clinical team.

2. Greater Efficiency and Comfort
Lower stress levels can lead to a smoother, faster procedure. In many cases, physicians may be able to complete the biopsy more efficiently and with fewer samples compared to a biopsy in the lithotomy position. This simple adjustment in positioning improves comfort for both the patient and the clinician.

3. Improved Pain Tolerance
Patients in the lateral position tend to tolerate pain better, both psychologically and physically. Not seeing the equipment helps reduce anticipatory discomfort, while lying on the side is inherently more comfortable than the traditional lithotomy position.

Dr. Bott’s Tips for Creating a Patient-Friendly Biopsy Experience

We asked Dr. Bott to share his practical advice for implementing the patient-friendly position. Here are his key recommendations:

1. Practice the Lateral Position Technique
Ensure you are comfortable and confident performing biopsies with the patient in the lateral position. With training, this approach becomes just as efficient as traditional methods and much more comfortable for the patient.

2. Use “Vocal Anesthesia”
Ask a dedicated nurse or assistant to engage the patient in conversation throughout the procedure. This technique, known as “vocal anesthesia,” helps normalize the experience. As Dr. Bott explains, “It’s very easy to do. When the patient is talking, their mind is taken off what’s going on behind them. I can perform the biopsies while they stay calm and avoid moving.”

3. Play Music
Invite the patient to choose music they enjoy. This simple gesture helps them relax and feel more at ease during the procedure. According to Dr. Bott, it all comes down to creating the right atmosphere. The more soothing and less clinical the environment feels, the more relaxed and cooperative the patient will be.

Final Thoughts

While prostate biopsies are routine for urologists, they can be a major source of stress for patients. It is the physician’s responsibility to create a supportive, calming environment through music, conversation, or by adopting the patient-friendly position to make the experience as comfortable as possible.

Sources :

• 1. Prostate Talk Podcast:  https://podcast.ausha.co/prostate-talk/unveiling-the-power-of-fusion-biopsies
• 2. Miller SJ, Sohl SJ, Schnur JB, et al. Pre-biopsy psychological factors predict patient biopsy experience. Int J Behav Med. 2014 Feb;21(1):144-8. doi: 10.1007/s12529-012-9274-x. https://pmc.ncbi.nlm.nih.gov/articles/PMC3859517/
• 3. Boesen L, Nørgaard N, Bisbjerg R, et al. Office-based Magnetic Resonance Imaging-guided Transperineal Prostate Biopsy Without Antibiotic Prophylaxis: A Real-world Clinical Utility Study. Eur Urol Open Sci. 2023 Dec 23;59:71-77. doi: 10.1016/j.euros.2023.12.002.. https://pubmed.ncbi.nlm.nih.gov/38298768/