Analgesia for Prostate Biopsy: Efficacy of Diclofenac Patch versus Diclofenac Suppository as Compared to Placebo during Prostate Biopsy

Background and Aims: Trans-rectal ultrasound guided prostate biopsy (TRUS) remains the gold standard to diagnose patients with prostate cancer. The purpose of this study is to prospectively evaluate the efficacy of diclofenac suppository versus diclofenac patch as compared to placebo, on pain reduction during prostate biopsy. Methods: A prospective, randomized, single-blind, placebo controlled study was performed in 73 patients requiring transrectal ultrasound guided prostate biopsy (TRUS). Patients were randomly allocated to receive 100 mg diclofenac suppository or 100 mg diclofenac patch or matching placebo 1 hour prior to the procedure. They were asked to indicate on a 10 cm visual analogue scale the degree of discomfort during probe insertion, needle penetration and four hours post biopsy. Statistical analysis was done using one way ANOVA. The data was analyzed using SPSS version 10.0. Results: Patients given diclofenac suppository and diclofenac patch had statistically significant lower four hour pain scores than those who were given placebo. There was no statistically significant difference in the pain scores between the three groups during probe insertion and needle penetration. The three groups were similar in regards to age, prostate volume, biopsy number, prostate specific antigen levels, histological diagnosis and complication rate. Conclusions: Diclofenac in the form of a patch or suppository does not confer a superior intraprocedural analgesic effect compared to the placebo, but it reduces post procedural pain to a significant extent. We do not recommend its use as a single agent analgesic for prostate biopsy and it should be used as an adjunctive analgesic for reducing post procedural pain.