Replies to I am followed at UCLA and my urologist continues to prefer the transrectal approach for the…

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Prostate Cancer | Last Active: Sep 5 4:14pm | Replies (51)

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@rbtsch1951

I am followed at UCLA and my urologist continues to prefer the transrectal approach for the majority of patients. In the course of 4 years on active surveillance I have had 4 transrectal procedures, and while uncomfortable, I would not describe them as painful. Premedicated with oral antibiotics before and continued after procedure as well as an intramuscular antibiotic injection at the time of the procedure, I had no problem with infections, thankfully, and only briefly had some small blood in urine and semen. Unfortunately my most recent biopsy showed a progression fro a Gleason 3+4 to Gleason 4+5 (in spite of MRI showing no changes in primary lesion and a low Oncotype score). About to embark on SBRT and ADT, they will do a SpaceOAR rectal space er via a transperineal approach in preparation for my radiation therapy. Knowing the road I am heading down, I am feeling more anxious, and they have offered light sedation with diazepam (Valium) which I think I will accept.

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Replies to "I am followed at UCLA and my urologist continues to prefer the transrectal approach for the..."

mauk | @mauk | Aug 31 1:17pm

which forn of SBRT?

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jc76 | @jc76 | Sep 1 6:56am

@rbtsch1951
Per my Mayo PCP, and my Mayo urologist, and UFHPTI and Mayo R/Os, transrectal is not the most recommended form of doing biopsies for prostate cancer. Doing it transpernia does require more experience and expertise.

It also can use things like MRI/Fusion to do biopies. I have read post on MCC that also said could do more areas of prostate. For me I did not want the extra worry of increased infection and for those who did get it would all tell you made huge mistake not asking for transperenial.

Transrectal is usually done without ansesthesia were transperenial is. Now I am not speaking for all those who got biopsies just my experience with it and what my medical providers told me.
Your orignial biopsie was postivve Gleason Score for prostate cancer. Where you offered treatments at that time? IF not why not? 3+4=7 indicates abnormal cancer cells.

You mentioned SBRT. Which form? Proton or Photon? Very different ways of radiating your prostate but both have same success rates.

At 3+4=7. If you had had a Decipher test then it could have determined your risk level. If low risk you would (at least for me) necessarily be recommended for ADT. AT 4+5 you are. So addressing it back at 3+4 should have come with recommendations on treating it to prevent it from getting worse like it did.

You mentioned some test. Consider (I had them) Decipher, PSMA. Space Oar is done to provide some space between your colon and prostate. You did not mentioned markers being put in but you mentioned SBRT. Asked if you will get markers and if not why?

I would recommend the light sedation and valum they offered with your Space/Oar. I did not like the feeling at all. I think mostly mental, stress, and fear, was main cause as I was not on MCC then so could not get the experience of others at the time. I know when I got on MCC I could not post my experience with my prostate diagnosis, tests, treatments to help those just starting off without feedback from those with personal experiences.

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