Prostate cancer screening using fine-needle aspiration cytology prior to open prostatectomy.

We performed a prospective study to evaluate fine-needle aspiration (FNA) cytology as a screening tool of carcinoma of the prostate in 159 men with normal digital rectal examinations and acid phosphatase prior to open prostatectomy for voiding symptoms. The incidence of carcinoma of the prostate was 5.6%. 4 patients had A1 lesions and 5 had A2 lesions. Only one A2 lesion was malignant cytologically. The sensitivity was 56%, specificity 69%, positive predictive value 24% and negative predictive value 90%. Sufficient cytologic specimens were provided in 66% of cases. While FNA is at least equal to core biopsy as a diagnostic modality of palpable prostatic abnormalities, it does not prove to be an adequate screening modality for occult carcinoma of the prostate in the prostatectomy candidate.

The effects of intraurethral lidocaine anesthetic and patient anxiety on pain perception during cystoscopy.

Despite current practice there is no evidence to demonstrate the efficacy of intraurethral lidocaine gel as an anesthetic for rigid cystoscopy. To evaluate the usefulness of lidocaine in decreasing pain associated with cystoscopy, we performed a prospective, randomized, controlled, double-blind study comparing lidocaine gel with a water based lubricant. The effects of pre-procedure anxiety and prior experience with cystoscopy on pain perception were also evaluated. Physician perception of pain experienced by the patient was compared with the actual pain experienced. We found no decrease in pain perception in men or women following lidocaine gel instillation with a 5 or 10-minute dwell time compared to instillation of the plain lubricant. Increased preprocedure anxiety correlated with increased pain perception in women. Personal experience with prior cystoscopic procedures significantly decreased the current pain perception in men. Physicians underestimated the patient pain perception in all groups. Overall, we found the use of lidocaine gel to be of no benefit in routine rigid cystoscopy. Lowering pre-procedure anxiety may decrease the amount of pain perceived by women but not by men.