Prostate Biopsy Complication

I had two biopsies 12 cores each and never really had much Of a problem after they were done. I do not recall people talking about this as a problem.

Maybe a transperineal biopsy will work better next time.

Most folks focus (rightly) on potential biopsy infection issues, because they (although a rare occurrence) can be very serious.

However, studies indicate up to 25% of men have transient lower urinary tract symptoms (LUTS) after biopsy with slightly higher rates reported after transperineal biopsies.

Fortunately, these issues are usually more of a minor annoyance and transitory, but in some cases they can last quite a long time….as in my case.

From what I’ve read in the studies devoted to prostate biopsy complications my situation is probably not due to a hematoma, which typically resolves in a few weeks or months; but more likely nerve damage or scarring that may have occurred from the procedure. The potential for this increases when a large number of cores are taken (21 in my case).
https://www.sciencedirect.com/science/article/pii/S0302283813005587

@handera
If I missed it did you have your biopsies done transrectal or transperineal? The transrectal per Mayo urolgoist at Jacksonville carries a 1-2 % chance of increased infections over transperineal. It is why I chose to have my transperineal.

I had 20 samples taken and had an original Gleason of 3+4=7 intermediate risk that was lowered to low risk after Decipher test.

I had no issues with my biopsies. I had it done with anesthesia and quite frankly when got out of procedure room could not tell I had it done or anytime afterward.

That does not help you I know as you are having issues. Good luck!!

Jc76,

Thanks for your response!

My MRI targeted biopsy was transrectal and under general anesthesia. I experienced little to no general pain immediately afterwards and no infection. In fact, the first week I was pleased with my results and thought everything was "as expected".

Initially I had the typical blood in urine experience, but that cleared up in two days.

My issue first occurred when my wife and I came together the first time…I experienced a lot of blood, much more than I was expecting and the pain, on my left side, was almost excruciating; so much so that we refrained for a couple of weeks.

The second time was still painful. At that point I became somewhat concerned, but I thought I just needed more time.

This went on for several more weeks.

It was not until ~9-10 weeks after my biopsy that the pain subsided to the place where I could say I was comfortable.

Although I didn't search much, I could not find a satisfactory explanation of my experience. I just chalked it up as being one of those “unfortunate few”.

Even now I experience just a “tinge” of an issue on my left side, which I have just learned to live with.

Recently I decided to do a “deep dive” to see what I could find out about my experience.

Via OpenEvidence I found out that my experience is a known complication of prostate biopsy (apparently rare) but the potential for it happening increases when a large number of cores are taken.

According to my research, the cause is due to nerve damage and possibly tissue scarring that places pressure on these sensitized nerves. According to these sources, if this occurs it can take from 6-24 months, up to 3 years, to fully restore the damaged nerves (sounds similar to restoration of function after experiencing ED after surgery).

I speculate that my particular mpMRI result was probably a factor for this complication.

In my case, three mpMRi lesions were targeted, along with the standard 12 core assay.

A large (2.2 x 1.1 cm) PIRAD 5 lesion (on my left side) was targeted with 4 cores (1.5, 1.4, 0.8 and 1.0 cm in length). They were all found to be Gleason 3+3, with 5% involvement.

Besides this, a 1.1cm left lateral base core was taken which was also found to be Gleason 3+3, with 5% involvement (0.04cm in length - a tiny amount). The interesting thing about this particular core was that it was also labeled with "perineural invasion".

Although I’ll probably never know for sure, I wonder if taking 5 cores from within a very small space (2.2 x 1.1cm), where one core actually pierced through a nerve, is the cause of my experience.

I'm sure this is a lot more than anyone is really interested in knowing, but that's everything I currently know about my situation...

Like a typical man, I've kept all this to myself up until now (as I said its a minor annoyance); however, since it has been 15 months I do plan to discuss with my urologist.

Handera, I’m not a urologist, but man, why so many cores? 21 seems like a lot!
And the trans rectal approach has been proven to miss certain cancers because some parts of the gland are simply not accessible via this approach. Perhaps they did have to get to one of these areas based on your MRI and could only reach it by going thru the gland completely multiple times (skewered). THAT would definitely cause damage.
As others have said and I will repeat: have a trans perineal MRI/sonogram guided biopsy next time. They will be able to access the ENTIRE gland with fewer punctures.

@handera
Not at all TMI.
Like you I found MCC cathartic when I would normally be silent as an introvert.

You have been through a lot. Hope your meeting with the urologist helps.

An MRI Transperineal Fusion Biopsy is the modern way to go . Some countries have banned Transrectal , plus certain Urologists refuse to perform this outdated method . The major concern in the past was the infection factor ( potential Sepsis ) however with todays newer antibiotics , this risk is about the same as the Transperineal . As you note however ,the transperineal gives you a better shot at reaching difficult to get at liasons .

I had a sonogram transrectal. procedure. I was extremely apprehensive due to the nature of the procedure, ie puncturing the rectum coliforms and all and poking the needle into the prostrate multiple times. To make matters worse an associate of mine died of sepsis 3months earlier from his needle biopsy. By the grace of God the antibiotic held and I had absolutely zero side effects. The urologist that I fired told me no worry only 1 in 750patiemts die of biopsy. I replied great if you aren’t that guy and I was gone to a center of excellence for the biopsy. Knowing now I would have held out for the trans perineal with anesthesia.

In Canada Anesthesia is uncommon for prostate biopsies . For me for example . 2 Transperiineal MRI Fusion Biopsies - A local numbing only . No problem , Easy peasy . Age near 85 . An antibotic before .

@billfarm
I was adamant about not having my biopsies done via transrectal. I was told increase in infection was 1-2 % and if I did get infected would only have to spend 2-3 days in the hospital.

My urologist did not want to do transpernial but transrectal. He used the excuse of my HF. But I got my HF and EP to contact him and they did saying my HF would not be a problem with gettig anesthesia. The transpernial (at least at Mayo Jacksonville) is done in a surgery room with anesthesia and anesthesiologist.

It removed the stress and anxiety over the procedure. I had not discomfort before, during and after. It is funny isn't it when you hear a urologist say only 1-2% or only 1 in 750 die in biopsy when they are not the patient.

One poster was told was only 1% infection rate and say guess he was lucky as he became one of the 1% with a real hard time getting rid of the infection. To each his own though some have no issue with the increased infection rate, nor the procedure done without anesthesia, nor going through rectum, ect.

That is why we are all different and need to do what is best for us. I challenged my urologist for what I wanted and did not accept his. We have to be our own patient advocate. It is our bodys and our cancer.