What is a Quick Rise in PSA?

No, definitely didn't mean to promote transrectal - but to be fair, they are both transrectal, one just puts the needle into the rectum as well as the probe, the other only puts the probe in the rectum. That being said, it seems like the prevailing thought is that transperineal does not require anesthesia. I even read that on the Mayo page. So, although I slightly wish I had looked for someone who did transperineal (and actually the doctor who did mine has done them before, but the facility doesn't have the equipment for it and it is a very large medical group with campuses all over a very very large city). However, even with transperineal I would still request the procedure without anesthesia since most of what I read says it isnot required. Anesthesia is not without risk (although lower risk than sepsis) but I don't always react well to it. I have had huge blood pressure drops after multiple procedures that used anesthesia. Twice it involved me blacking out, falling and getting injured. (Talking bp's around 70/38)
But yeah, if my doctor has said "you would only be in the hospital for a few days" - I would probably have gone home and started calling other offices to find a different doctor and caneclled the procedure with him. I agree that is callous and also adding unnecessary stress,

Although it was very painful during the procedure, I would like to follow up and say within a few hours it became a very dull ache type pain, not bad at all. Also, after that initial blood clot-ish ejection the first time I urinated briefly after the procedure, I have not seen anything else like that (in maybe 5 more trips to the bathroom). One time did see the slightest hint of pink at the beginning. So I'm glad about that. Also, havent seen much blood coming out the other side.

I definitely understand about wanting questioning practitioners. I actually had one Urologist for about 15 years. I was first seeing him for fertility as we tried to have another child. He is a well known urologist, specializing in for male infertility. He didn't see women. After a year or two there, one day at a visit I mentioned urinary problems (straining/hesitancy) and he performed some tests he didn't usually do and diagnosed me with BPH. So from a relatively young age (early 40s) I was being treated for BPH. He always mentioned at some point we may want to do something more drastic than medication, but given my age, it wasn't necessary yet. Somewhere along the line he gave me info about Urolift. I looked at the pamphlets and than even went online and read more information about it. Was even able to watch videos of the procedure online. The procedure didn't concern me too much - meaning it didn't frighten me - how they performed it. What worried me was that it didn't seem like a very good solution and seemed pretty invasive to the tissue. So I held off and would come across new options and would research them, like Rezum. Finally about 2 years ago as things got worse, I decided lets do something about this and went through all the tests to make sure I was a good candidate (which involved TRUS, cystoscopy and another extremely invasive test including all kinds of electrodes and a catheter).

Anyway, back to the point. After all the tests I went home and started looking into Urolift again, because it had been a few years and I was still apprehensive about. What I was reading was that the results were not great and only lasted a year or two. (But now you had these clips in you permanently) Within days my social media feeds started popping up all different stuff about BPH and procedures including Urolift as well as multiple clinical trials. So when I went to my follow-up with my Urologist, I asked about some of these procedures that were in clinical trials. He got kind of dismissive and angry, (my urologist of 15 years) like "none of those are very good and besides we're not participating in any trials at this time". Basically scolded me. So he went over all of my results and said I was a good candidate for Urolift and sent someone in to schedule the procedure.

Since I was still had my doubts about Urolift because it seemed traumatic to the tissue and everything I read basically said it didn't last very long I decided to do a little more research. With all these new options that kept popping up in my feeds (one or two on the streets) as well as clinical trials. The trials in particular looked like elegant design solutions to the BPH problem. So I cancelled my Urolift by phone - called and said I had a conflict and needed to reschedule. I never called back to reschedule. I reached out to the office of one of the doctors who was doing a couple of the trials, in my city. Made an appointment with no commitment and did all the tests and after I cleared the bar, became a clinical trial patient. A device was put into my urethra in the prostate area (via cystoscopy) for 3 months and then removed. I am now almost 2 years from starting that, and over a year and half since removal. It was very effective, the procedure wasn't too painful and best of all, it did not traumatically pierce the tissue. (Although one time while it was still in, I received quite the friendly inspection of my groin from a TSA agent.) The device worked really well, at least for a year. I do feel like I am getting more hesitancy again and retaining more again, but not straining like before. Since nothing was permanently put in me, or gouged out of me, I don't mind - it gives me the opportunity to try other options in the future as those options get better. All of that to say, because my urologist of many years got angry and wouldn't even discuss other options with me, I moved on. The future of my genitourinary system to function for all of its intended purposes deserved better than my long time doctor getting angry at me for asking questions.

Now one could wonder why I didn't go to the urologist heading the clinical trial who did the BPH device. I actually would have, he has one of the best bed side manners of any doctor I have ever been the patient of. However, at one of my visits while talking to him, he told me he only deals in urinary incontinence issues (which includes BPH) and between clinical trials and his patient load, he doesn't have time to treat anything else. He would have seen me if made an appointment to see him, but it would have taken several weeks to get in because he is at a large medical provider. He probably would have tested my PSA again and done a DRE, but then he would have referred me to someone else at the organization, which would require another wait of several weeks and it would still be a doctor I didn't know. So I opted to find someone within the medical group where my PCP is.

Also, as a final note since some might say, "your PSA is probably elevated by BPH" - I was diagnosed with BPH 12 or 13 years ago and my PSA was consistently 0.9-1.1 for all those years until 2023 when it doubled to 2.2 and this year when it jumped to 5.

Sorry for another long post. 😐

@spaceguy
Correct. But the difference is that nothing goes through the rectum when doing transperinal. The probe just sits in there (I had MRI/Fusion) procedure. The biggest difference is the needle under transrectal goes through the rectum where transperinal does not.

I preferred anesthesia. Many like me have a high anxiety stress issue and the procedure can and does cause a lot of stress and anxiety. With transperenial done with anesthesia (mine done this way at Mayo Jacksonville) there is no stress or anxiety and for me no pain or discomfort at all. I did not want the additiona risk of infection. I have read on MCC so many that did have it done transrectal the severe stress it caused when they did get infection and what they went through in hospital. It is important the risk is low (1-2%) but it is there and those that get infected will tell you would never have it done transrectal again.

For those reading this post I have copied the difference below from medical forum of the differences between the two so they know our posts are saying same thing.
________________________________________________________________________________
- Rectal (Transrectal) Biopsy: Yes, this method does go through the rectum. A needle is inserted through the rectal wall, typically guided by an ultrasound probe placed inside the rectum. It's commonly used for prostate biopsies but carries a slightly higher risk of infection due to the rectal bacteria.
- 🧪 Transperineal Biopsy: No, this method does not go through the rectum. Instead, the needle is inserted through the perineum — the skin between the scrotum and anus — while the ultrasound probe remains in the rectum for guidance. This approach reduces infection risk and allows better access to certain areas of the prostate.
So in short: rectal biopsies go through the rectum, while transperineal biopsies bypass it but still use rectal ultrasound for imaging.

LOL!

Man, that Urolift Doc sounds like a real winner. His anger was a dead give-away that his mind was closed. Good for you that you hit the road before irreparable damage could be done.
Phil

72 hours update: Have had almost no blood in urine or stool and no indication on semen yet. Have not really had any pain or discomfort since Friday. Felt ache in lower abdomen/groin area after first BM, but nothing since then. Wasn't too bad and since Friday evening I don't think I have had any pain. No fever or chills. No burning with urination and like I said - very minimal blood. (First time I went right after after procedure, a little on the second time I urinated on Wednesday and one or two times since then after BM. But just little drips of reddish and then clear. Nothing in BM since Friday - although BMs have been kind small and hard. Only other things to report: mild nausea every morning that seems to go away after I eat. When I went to grocery store yesterday every time I bent down or squatted to get something off a lower shelf, when I stood up again if I was too quick - I felt lightheaded.

Can't go wrong with an MRI in that situation just to be on the safe side...

I recommend an oncologist