Approximately 2 million men undergo prostate biopsies annually in the United States for the detection of prostate cancer. Due to rising rates of antibiotic-resistant bacteria and infections associated with transrectal prostate biopsy, the transperineal (TP) approach offers a much safer procedure and is becoming more commonly utilized.¹ Given the nature of the procedure, a prostate biopsy by any approach can be a traumatic experience for patients, including physical discomfort, anxiety, and/or embarrassment. As of today, no study has assessed whether virtual reality (VR) simulation can help improve patients’ experiences during TP prostate biopsy. It has been shown that VR simulation can help both adults and pediatric patients alike in a variety of procedural settings.^2-4 We aimed to study the role of VR immersion during TP prostate biopsies for reducing perceived anxiety and pain associated with the procedure.

We conducted an Institutional Review Board–approved, prospective, randomized study of 60 men who presented for TP prostate biopsy. The men were randomized 1:1 to undergo the procedure with VR, immersed in calming, natural scenery. The control group underwent the procedure without VR. The procedure was performed under local anesthetic with 1% lidocaine used to anesthetize the perineal skin and prostate gland per our established protocol. The primary outcome of our study was pain, anxiety, and degree of nausea during the procedure assessed by a validated 10-point visual analogue scale given pre- and postprocedure. Vital signs such as blood pressure, heart rate, and oxygen saturation were measured. For those who were in the VR group, patients were further asked if they would recommend VR for other patients. Mann Whitney U test was utilized to assess the difference between the 2 groups. The statistically significant level was P < .05.

All 60 patients were able to complete the TP biopsy.

The mean age (years) of the cohort was 70. Table 1 shows patient baseline characteristics by treatment modality. The VR group’s mean age was 69.3 vs 70.5 in the control group (P = .45). Both VR and the control group had similar preprocedure anxiety levels (VR 5.8 vs control 5.2, P = .33), as noted in Table 2. The mean postbiospy anxiety levels for VR and control group were 4.1 and 6.9, respectively. The overall change in anxiety was −1.75 for the VR group and 1.65 for the control group (P < .001). The mean pain level for VR and control group were 4.0 and 5.6, respectively (P < .05). These differences in anxiety and pain level are also depicted in the Figure. Among the 30 patients who were in the VR group, 27 patients recommended VR use for other patients (Table 3). No patients experienced any nausea or dizziness associated with the VR immersion during the biopsy.

Table 1. Patient Baseline Characteristics by Treatment Group

Table 2. Patient-reported Outcomes by Treatment Group

Table 3. Count and Percentage of Virtual Reality Patients Who Would Recommend Virtual Reality

In this study, we observed that TP biopsy is feasible in the office-based setting under local anesthetic alone for the majority of patients. VR immersion technology can be a useful tool in improving patients’ experience by reducing both pain and anxiety during the procedure.