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NCT Number: NCT07578324

TENS as an Adjunct to Local Anaesthesia During Transperineal Prostate Biopsy: A Randomized Sham-Controlled Trial

Transperineal prostate biopsy is a safe and effective method of diagnosing prostate cancer. When performed under local anaesthesia in an outpatient setting, it can cause significant pain, particularly during the periprostatic nerve block - the injection of local anaesthetic around the prostate. Better pain management during this procedure may improve patient comfort and encourage wider use of the transperineal approach.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, low-cost method of pain relief that works by delivering mild electrical impulses through the skin. A preceding pilot study at our centre (n=84) found that TENS used alongside local anaesthesia was associated with significantly lower pain scores during periprostatic nerve block and biopsy sampling, with no device-related complications.

This study aims to confirm these findings in a larger, formally powered, triple-blind, randomized controlled trial. Participants will be randomly assigned to receive either active TENS or sham TENS (electrodes applied but no electrical current delivered) in addition to standard local anaesthesia. Neither the participant, the operating urologist, nor the nurse recording pain scores will know which group the participant is in.

Pain intensity will be assessed at four stages of the procedure using a 0-10 numeric rating scale. Participants will be followed up at 30 days after the biopsy.

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Key information

Conditions

Prostate Cancer (Diagnosis) Agnosia Disease Genital Diseases Genital Diseases, Male Genital Neoplasms, Male Male Urogenital Diseases Neoplasms Neoplasms by Site Nervous System Diseases Neurobehavioral Manifestations Neurologic Manifestations Pain Pain, Procedural Pathologic Processes Pathological Conditions, Signs and Symptoms Perceptual Disorders Prostate Biopsy Prostatic Diseases Prostatic Neoplasms Signs and Symptoms Urogenital Diseases Urogenital Neoplasms

Age range

40 year and older

Sex eligibility

Male

Study type

Interventional

Phase

Not applicable

Primary location

Department of Urology, Medical University of Gdansk

Gdansk, Pomeranian Voivodeship, 80-214, Poland

Location contact

Bartłomiej Marczak, MD

CONTACT

[email protected]

+48 790 710 909

About this study

This is a single-centre, prospective, randomized, triple-blind, sham-controlled, two-parallel-group superiority trial. The study builds on a preceding pilot study (TENS 1, n=84) which demonstrated large effect sizes for TENS-associated pain reduction during transperineal prostate biopsy under local anaesthesia.

Triple-blinding is achieved through a three-component procedure: amplitude titration is completed before the operating urologist enters the procedure room; a physical opaque screen is placed between the TENS device and the operative field; and participants are instructed not to verbalise device-related sensations during the procedure.

The primary outcome is NRS pain score during periprostatic nerve block, assessed within 30 seconds of completion of bilateral periprostatic infiltration by an independent outcome assessor blinded to allocation.

Exploratory outcomes include preoperative pain catastrophizing, preoperative anxiety (STAI-S), and the effect of prior biopsy experience on procedural pain.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Male patients aged 40 years or older
  • Indication for prostate biopsy: elevated serum PSA (as per institutional protocol and EAU guidelines) or abnormal digital rectal examination (DRE)
  • Suspicious lesion on multiparametric MRI classified as PI-RADS score 3 or higher (version 2.1)
  • Scheduled for transperineal MRI-ultrasound fusion-guided prostate biopsy under local anaesthesia
  • Ability to provide written informed consent

Exclusion criteria

  • Prior treatment for prostate cancer (surgical, radiotherapy, hormonal or focal therapy)
  • Contraindications to TENS: cutaneous damage or dermatologic conditions at electrode application sites; cardiac pacemaker or implantable cardioverter-defibrillator (ICD); uncontrolled cardiac arrhythmia or congestive heart failure; history of epilepsy or seizure disorder; metallic implants near the stimulation site; malignancy at or near the stimulation site
  • Contraindications to transperineal biopsy: active urinary tract infection; bleeding disorder or ongoing anticoagulation not amendable to bridging; anatomical abnormalities preventing safe prostatic access
  • Known allergy or intolerance to local anaesthetic agents or biopsy-related materials
  • Severe comorbidities or unstable medical condition compromising procedural safety
  • Inability to complete questionnaires
  • Participation in another interventional clinical trial within 30 days prior to enrolment

Treatment and study plan

Transcutaneous Electrical Nerve Stimulation (TENS)

Device

Cefar Rehab X2 device (Class II, Type BF). Symmetrical biphasic compensated pulse; 80 Hz; 180 µs pulse duration; amplitude individually titrated. Two pairs of 5x5 cm electrodes in perineal region. Initiated 3-5 minutes before local anaesthesia, continued throughout procedure.

Sham Transcutaneous Electrical Nerve Stimulation

Device

Identical electrode placement to active group. Device activated without delivering electrical current. Indistinguishable from active TENS by participant, operator, and outcome assessor.

Primary outcomes

  1. NRS Pain Score During Periprostatic Nerve Block

    Time frame: Immediately after completion of periprostatic nerve block (intraoperative)

    Patient-reported pain intensity during periprostatic nerve block (PNB), assessed using a Numeric Rating Scale (NRS, 0-10, where 0 = no pain and 10 = worst imaginable pain). PNB consists of periprostatic infiltration ( 10 mL 1% lignocaine under real-time ultrasound guidance). NRS assessed verbally by an independent outcome assessor (Nurse B) within 30 seconds of completion of the PNB injection, before the next procedural stage begins. Standardised verbal NRS explanation provided to all participants before the procedure.

Secondary outcomes

  1. NRS Pain Score During Ultrasound Probe Insertion

    Time frame: Immediately after ultrasound probe insertion (intraoperative)

    NRS (0-10) assessed within 30 seconds of probe placement, before local anaesthesia administration begins.

  2. NRS Pain Score During Perineal Infiltration

    Time frame: Immediately after perineal infiltration (intraoperative)

    NRS (0-10) assessed within 30 seconds of completion of perineal skin and subcutaneous tissue local anaesthetic infiltration.

  3. NRS Pain Score During Biopsy Sampling

    Time frame: Immediately after fusion-targeted biopsy sampling (intraoperative)

    NRS (0-10) assessed within 30 seconds of the last biopsy core being obtained.

  4. Procedural Safety and Tolerability

    Time frame: Through 30-day follow-up

    Incidence and severity of adverse events classified per Clavien-Dindo grading system.

  5. Willingness to Repeat the Procedure

    Time frame: 30-day follow-up visit

    Single question (yes/no/unsure) assessing patient willingness to undergo the same procedure in the future.

  6. Blinding Integrity - James Blinding Index

    Time frame: Immediately after biopsy sampling, before unblinding

    Participant blinding assessed by single question posed by independent outcome assessor immediately after biopsy sampling: which group the participant believes they were assigned to (active/sham/no opinion), plus certainty rating (1-5).

  7. Operator Satisfaction

    Time frame: Immediately after procedure

    Single-item Likert scale (1-5, where 1 = very dissatisfied and 5 = very satisfied with procedural conditions), recorded by the operating urologist immediately after the procedure, assessing overall satisfaction with procedural conditions during the biopsy.

  8. Patient Satisfaction

    Time frame: Immediately after procedure

    Single-item Likert scale (1-5, where 1 = very dissatisfied and 5 = very satisfied), recorded immediately after procedure by independent outcome assessor.

  9. Amsterdam Preoperative Anxiety and Information Scale

    Time frame: Administered before the procedure.

    Amsterdam Preoperative Anxiety and Information Scale (APAIS; 6 items; Moerman et al., Anesth Analg 1996;82: 445-451; Polish forward-backward translation). Administered before the procedure. Association with primary outcome assessed by Spearman correlation as covariate.

  10. NRS-Anxiety

    Time frame: Administered before the procedure and immediately after biopsy sampling to assess pre-to-post procedural anxiety change.

    NRS-Anxiety (0-10; single item: "How anxious are you right now?"). Administered before the procedure and immediately after biopsy sampling to assess pre-to-post procedural anxiety change. Pre-to-post delta reported as exploratory outcome.

  11. TENS Amplitude vs Pain Reduction

    Time frame: Intraoperative (active group only)

    Actual TENS amplitude used (mA) recorded for each participant in the active group. Spearman correlation between amplitude and NRS reduction during PNB.

  12. Pain Catastrophizing Scale (PCS-13)

    Time frame: Before the procedure

    Pain Catastrophizing Scale (Sullivan et al., Psychol Assess 1995;7:524-532). 13-item self-report questionnaire, score 0-52. Three subscales: rumination, magnification, helplessness. Polish version available. Administered before the procedure as covariate for primary outcome analysis.

Study contacts

Contact information is provided by the study sponsor or research team.

Bartłomiej Marczak, MD

CONTACT

[email protected]

+48 790 710 909

Sponsors and collaborators

Lead sponsor

Medical University of Gdansk

Other

Registry information

Official study title

Transcutaneous Electrical Nerve Stimulation as an Adjunct to Local Anaesthesia During Transperineal MRI-Ultrasound Fusion-Guided Prostate Biopsy: A Randomized Triple-Blind Sham-Controlled Trial

Acronym: TENS 2

Important dates

Study start
2026
Primary completion
2027
Study completion
2027
First posted
May 11, 2026
Registry last updated
May 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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