Virtual hypnosis with HypnoVR system during prostate biopsy: a new tool to increase patients' comfort

Prostate biopsy is often perceived as an invasive and painful procedure, frequently associated with significant emotional distress. Despite the use of local anesthesia, a considerable proportion of patients still report pain and anxiety. Hypnosis has been demonstrated to reduce procedural discomfort; however, its clinical use is limited by the requirement of trained professionals and time constraints. This preliminary study evaluates the feasibility and potential benefits of digital sedation using immersive virtual reality (VR) with the HypnoVR system in five patients undergoing prostate biopsy. Patients selected their preferred virtual environment and started wearing the device four minutes before the procedure. Anxiety and pain were assessed using Visual Analog Scales (VAS), and vital signs were monitored as physiological surrogates. Results revealed low pre-procedural anxiety (median 1/10 ±1) and moderate pain during (median 5.6/10 ±1.1) and immediately after biopsy (median 3/10 ±2.2), with no pain reported at 24 hours. All patients reported high satisfaction and no complications occurred. Transrectal biopsies were performed without anesthesia, while the transperineal ones were carried out using subcutaneous anesthesia only, with no significant differences in tolerability. Although limited by its small sample size, this initial experience supports the potential role of VR-based hypnosis as a non-pharmacological, patient-centered approach to enhance comfort and reduce invasiveness during prostate biopsy.