Immersive Virtual Reality for Pain and Anxiety Reduction During Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
In brief
Virtual reality shows no clear pain or anxiety benefit in prostate biopsy trials
Across four randomized trials involving 454 patients, immersive virtual reality did not significantly reduce pain or anxiety during transrectal ultrasound-guided prostate biopsy. The pooled results were highly inconsistent and unstable, although no major device-related harms were reported; evidence is too uncertain to support routine use and larger standardized trials are needed.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 20 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Khaled Aljenfawi, Malek Hasan, Ebraheem Albazee, Said Yaiesh
- PMID
- 42941659
- DOI
- 10.3390/jcm15208145
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 28 October 2026).
Abstract
Background: Transrectal ultrasound (TRUS) guided prostate biopsy is a distressing procedure associated with significant pain and anxiety, even with routine local anesthesia. Immersive virtual reality (VR) has emerged as a promising non-pharmacological distraction strategy, aiming to modulate pain perception via sensory overload and attentional shift. Methods: A comprehensive search of five databases, including PubMed, Web of Science, CENTRAL, Scopus, and Embase, was conducted up to April 2026. RCTs comparing intra-procedural immersive VR to standard care were included. Primary outcomes were biopsy-related pain and anxiety. Secondary outcomes included patient satisfaction and procedure-related adverse events. Standardized mean differences (SMD) were pooled using a random-effects model. Results: Four RCTs involving 454 patients were included. There was no significant difference between the two groups regarding biopsy-related pain (N = 355 patients, SMD: -1.24, 95% CI [-2.53, 0.04]; p = 0.06) and biopsy-related anxiety (N = 361 patients, SMD: -1.37, 95% CI [-2.76, 0.02]; p = 0.054). These analyses demonstrated significant inter-study heterogeneity (I2 > 95%), and leave-one-out sensitivity analyses revealed instability in the pooled estimates. Nevertheless, VR appeared feasible and well tolerated, with no major device-related adverse events reported in the available trials. Conclusions: The available evidence remains very uncertain regarding the effect of immersive VR on pain and anxiety during TRUS-guided prostate biopsy. Substantial clinical and statistical heterogeneity and instability of the pooled estimates limit definitive interpretation, and the current evidence is insufficient to support routine implementation. Larger, adequately powered, and standardized RCTs are warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.