Anesthesia for a Prostate Biopsy

For your prostate biopsy, you may want to check your Gleason score, risk grouping level, and whether the cancer has gone outside the capsule. You can also do a Decipher test which can, through your genome, indicate your risk of aggressiveness in the tumor. Many men with low to intermediate risk prostate cancer can wait 6 to 12 months before treatment if necessary.

One thing the experts advise against is moving too fast with procedures and treatments until you know all your options.

Important caveat: I am not a medical professional, so check out all that I have written here with a qualified doctor or other qualified medical person.

Good luck to you!

Just a couple minor points. I had a transperineal biopsy at Mayo last May '23, and it was under anesthesia. That is how they do it.

When I had Tulsa Pro in November '23 (not at Mayo) they needed a clearance, basically it is a form you can give any one of your doctors who has seen you in past and they can fill it out. They also need an EKG. I actually used an EKG from my watch app as all they need is a single lead. They also told me some of the urgent cares around the country do school clearance, pilot clearance, and other clearances and I could use a place like that, but it looked like $300 or so at one place I looked, so I just used my watch EKG and one of my doctors I see for blood pressure filled out the clearance form very thankfully.

I’m 63, I tried the in office procedure and the pain was so unbearable and my anxiety level so high, we did it under anesthesia at the hospital. But, with your cardiac history, if you can hold out a few months, I would. Unless you can handle a tube and needles up your butt for however minute it might take for you. So that’s my nickel’s worth.

I had transrectal biopsy with only a local.

All things considered, it was quite tolerable

Rick137: I had anesthesia for my biopsy and would not do it without it if I have to do it again.. Doctor's, even with the Decipher test, cannot tell you definitively, whether extra waiting time will or will not result in spread outside your prostate.

@rick137
My urologist wanted me to do the biopsies through rectum because I have heart failure and a ICD/Pacemaker. I had had many surgeries and procedures under general anesthesia so I challenged this and asked them to contact my heart failure doctor.

My heart failure doctor confirmed I was okay to have genearl anesthesia. Thus with general you do not feel anything versus the stress of going through anal and being awake. Anal also comes with increased infection rates. You say you have AFIB and the amount of stress having it done rectally would be in my opinion a consideration to not have that much stress on you.

You mentioned AFIB. I have that off and on and a lot of PVCs. Again my EP and heart failure said that I was okay for anesthesia. I see some are commenting on Decipher. Dechiper is a genetic test done on the biosies already taken and give you a much more precise risk level than the biopsies that can be subjective. I would also ensure you have a PSMA and bone scan. All of these help YOU decide on your treatment options and what is best for you.

The very latest (February 1, 2024) ProBE-PC randomized clinical trial results comparing infectious complications of Transrectal prostate biopsy versus transperineal prostate biopsy produced very interesting results.

Conclusion from the report:

“Among men undergoing transperineal or transrectal prostate biopsy, we could not demonstrate any difference in the infectious or noninfectious complications. Both biopsy approaches remain clinically viable and safe.”
https://www.auajournals.org/doi/abs/10.1097/JU.0000000000003788
I had a transrectal prostate biopsy under full anesthesia and will do the same if/when I must get another biopsy.

Regarding prostate biopsy under local anesthesia, I have only my experience to go on, but I found it less bothersome than most dental work. Urologist used an ultrasound probe thru the rectum. That insertion was no worse than a digital rectal exam. The local shot was less uncomfortable than the locals I've received for, say, dental crowns. The biopsy itself was 12 shots of an injector. The only thing I noticed was the sound of the mechanical device and a nom-painful "vibration". I think staying relaxed - even breathing, not tensing the anus - may have helped.

@trusam1
You are one of the fortunate ones to be able to do this without anxiety and worry. I like many others would not relax and the stress and anxiety over the procedure while awake was not somthing I wanted to do.

There can be serious infections when doing this procedure via rectal. The incidence of infection is much higher than doing it transperinial where the risk of infection is almost zero. My urologist warn me of the infection rate (I think it was 2%) but said was serious and hospitalization would be necessary.

They do use a pre antibiotic to lower the risk of infection but I wanted the method with lowest infection risk and the least anxiety and worry I could do. I would not even know I had the biopsies if had not woke up after procedure as had no pain, no discomfort, prior to, during , and nothing at all after.

@jamesharrison Excellent advice!!