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Transperineal vs Transrectal biopsy
Prostate Cancer | Last Active: Sep 5 4:14pm | Replies (51)Comment receiving replies
From what I've read, transrectal isn't common these days, due to the possibility of infection.
Transperineal seems to be the standard.
That's what I had, anyway.
But that doesn't get us out of the horrible rectal invasion.
I can only speak to the experience that I had.
Although the actual biopsy needle goes in through the perineum, my urologist also slid in an ultrasound probe in the rectum. (totally the not-fun experience it sounds like)
The idea is that they have the MRI scan available & use that as a guide, using a grid system.
The ultrasound enables them to pinpoint exactly where the needle is going.
So they basically play Battleship with your prostate.
It's not all bad, though.
This is just a day at the office for them & my urologist kept me distracted with a long chat about arcade games.
It totally worked.
Replies to "From what I've read, transrectal isn't common these days, due to the possibility of infection. Transperineal..."
I have had six prostate biopsies in the last decade. I joke with my urologists that I should be inducted into the Guiness book of records :). Of these six, one was radndom needle biopsy, all the rest were MRI-guided. The first 5 were transrectal (one under sedation at UCLA), and the rest without sedation at Kaiser and an independent urlologist. I did not have any infection or complication with any of these 5 trasrectal biopsies. The most recent biopsy done at Keck USC was transpirenial under sedation. Given the location of the suspicious lesions, the urologist decided tranperinial biopsy was the most suited, and that is what I got.
But I did get serious infection earlier this year at a local urologist who conducted a urodynamic study of my bladder, which included inserting probes both through the urethra and rectum. It was not fun at all and worse it required three courses of antit-biotics to clear the ensuing infection.
I don't think that transperineal is the standard in the USA, yet. I was not offered it in Tucson - a fairly large and progressive city. In fact, researching Mayo Arizona, I found that they claim to be one of the few centers (of excellence!) in Arizona that offers the transperineal biopsy. I am scheduled for transrectal biopsy next week - MRI fusion-guided - because that is what my urologist offers. I will see a Mayo Clinic doctor for consultation and consideration of unique focal treatment in late October, which is the first appointment available. The Mayo doctor said to keep my appointment and get the biopsy done now, then send pathology report to him. I was "freaking out" about this topic until I saw a great, detailed presentation by urologist, Dr. Michael Ahdoot on YouTube. His presentation helped me understand and relax. You should see it!!! https://youtu.be/bK1ozkOgatw
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I saw my urologist yesterday to go over my recent repeated PSA labs and the MRI from late July. He recommended the biopsy, which I agreed to believing we all need the information to be gleaned from the procedure. It will be the MRI fusion/guided intrarectal biopsy on 9/9. I truthfully trust and respect my urologist quite a bit, so I am sticking to the plan, comfortably. I am especially glad that we got it scheduled as soon as we did. I tried to advocate for bypassing the biopsy and getting the RARP done asap. He was funny about that idea -- and said no urologist would do the surgery without the pathology report. So.....