Hi heavyphil, thank you for your advice. After i confirmed that my doctor was not doing transperineal, I read some more papers online about the two options to determine if I wanted to change my appointment. I was kind of leaning towards changing to transperineal, purely from an infection risk standpoint. However, in the end most of what I read indicated infection is really rare in either case. I also searched and could not easily figure out which urologists in my area performed transperineal biopsies (they don't make it easy to figure out). So in the end I decided to stick with the appointment I had. I determined it would take me at least a week to find a urologist who did transperineal and then I would have to get an appointment to see them because they wouldn't perform a biopsy without doing their own exam and tests, and then they would schedule me for the biopsy after that and that whole process could take several weeks if not months. I didn't know if I could handle that much more waiting. I also liked the urologist I went to see. He asked a lot of questions, allowed me to ask questions too. As he was performing his exam based on questions he asked, he did more thorough exams based on my answers. When he asked about family history, I explained my father died in his late 50s, long before they would have been testing men for prostate cancer. However, I mentioned a maternal uncle who died from prostate cancer and he listened and included that in his note as familial history. When he performed the DRE he was more thorough than PCPs have been in the past, feeling around on the prostate vs a quick squeeze. He noted it didn't seem too large, but that one side was firm. So based on his thoroughness and also asking how I felt, he didn't want me losing sleep over waiting 6 months or a year for another PSA. He noted if I had prostatitis that my PSA would be much higher so he thought it was unlikely an infection. After the exam and questions he said its possible everything is fine but given PSA history over last 2 years, family history, etc, there is reason to be concerned, and doing a biopsy now was warranted.
All that being said, this morning was the day. So I thought I would give some details about the process and how it went, since so many people say its quick and easy and relatively pain free. I did find a couple studies that said positioning the patient on their back with legs in stirrups was less painful than lying on their side. It also said that this position allowed better views with the ultrasound for the doctor. Although it seems most go with the side position. When I went in the room, I saw a chair type place to sit, so I thought maybe I would not be on my side. I asked the nurse and she said I would be on the side. (The 'chair' reclined, the legs came uo and it became completely flat) Nurse prepped me. A shot of antibiotic in the right glute. A little bit later she put lidocaine in my rectum, using her finger I think. Neither of those caused any pain or discomfort.
Then the doctor came in and talked to me for a minute, going over the procedure and the risks again. When I first got their I saw the probe - and it is not the same probe used for a regular TRUS. In my research of prostate biopsies, it said the probe was about the size of a man's thumb. Yes, a man's thumb if he happened to be a giant or a cave troll. When he got started, first it was his finger - I assume to feel the way and maybe to prep you for it us coming. He then said, 'ok now the probe' or something like that and the probe entering me was so painful, both the pressure of it and the size/shape. Probably doesn't help that the head of the probe is kind of a weird shape, so as he turned it, it hurt. He then did two shots internally to numb the pain. Let's just say the earlier topical lidocaine didn't help much. Or maybe it did and the pain would have been unbearable without it? Again painful. He then said we are going to start taking samples now. I slowed him down by asking a couple questions and then he started. Those first 4 samples were very painful - when the needle jabbed, it didn't hurt - just like a little thump. But positioning of the needle or whatever was going on down there prior to the needle injecting to the prostate - that hurt. The last one on the right didn't really hurt. He then moved to the left side of prostate and on the left side I didn't feel much at all. So perhaps it was that the left side shot worked better or perhaps he didn't wait long enough to start on the right.
I can actually see why the lying on the back position could possibly be less painful. It seems like a more anatomically correct position to be in, if somebody is trying to insert a large object into your anus and rectum. I could also see how that would be a better orientation for the doctor to be able to position the probe - I think it would be easier to look at the perineum and visualize where the prostate is and guide the probe, vs sliding it from the side.
At that point it was over, he reiterated it would take 5-10 business days to get results etc and he left. The nurse stayed on to clean up and to give me 5 -10 minutes to lie there to make sure everything was ok and that I didn't feel light headed. She checked me to make sure I didn't have any unusual bleeding and said I could get dressed and leave when I was ready.
I got dressed after cleaning myself a little better and went to my car. I stopped at the bathroom to make sure I could urinate. I had no problem - when I started there were two little blood clots that came out but other than that my urine color seemed normal. By the time i got to the car, I was feeling a lot of discomfort in my rectal area, so I took two tylenol.
I came home and showered and got in bed and by about two hours after the end of the procedure I was only feeling mild discomfort.
Anyway, sorry for being so long winded and a little graphic, but I figure people looking for more information like first hand accounts - vs the medical website information you find online that says - "quick and easy procedure with mild discomfort. Doctor uses ultrasound to guide procedure, takes some samples and you are on your way." 🙂
I will say, if I ever have to get another biopsy, I will be asking for transperineal and positioned on the back as well.
Now I just have to wait 2 weeks for results, so the waiting begins again.