Transperineal vs. transrectal: Which is worse?

In the past 9 months, I have had two biopsies. 1 transperineal and 1 transrectal.

I was put under for both. After waking up, pain was very minimal for both. Transperineal was a little more soreness and blood, but pain level was still low.

Have never had spacers inserted.

@charlesprestridge Thanks. I will not be under general anesthesia for this. Local, as I was for the biopsy.

@tjnoffy I had a perineal biopsy a few months ago , local numbing. It wasnt real pleasant but not much pain as they numb ahead of anywhere they insert needle. Just some discomfort and dull jabbing felt. Drove myself home 15 minutes after procedure. No real pain after. No enema required, almost zero chance of infection, so that was a plus

I had a perineal biopsy under local anesthetic. There was some pain just prior to each numbing application, but I found it all very tolerable. The main thing I remember is what seemed like a loud click when each core was taken. This didn't cause pain, except my vivid imagination was a bit disturbed.

Afterward, my main thought was why was I dreading this so much?

My markers and spacer were placed while I was still under general anesthetic from HDR brachytherapy.

I have done all three procedures. I think the rectal biopsy is the easiest to endure, with lidocaine. The perineal biopsy I did with just lidocaine. A little more discomfort. They did offer a IV sedation and I declined it. The doc doing the procedure told me that some men don’t do as well as I did. Depends on your discomfort level. I did the spacer and marker procedure with only lidocaine. Again they offered me IV sedation. I declined. They told me that about half the men take the sedation. These procedures take about 15 minutes start to finish. You will make it through one way or another. My brother recently had both the perineal biopsy and then the marker/spacer procedure done and both times they did general anesthesia. I think more and more we will see a greater level of usage of stronger anesthesia methods. Enough men are complaining I think to make the doctors take notice. I suffered no complications from any of the procedures. Look at it this way….You have one more difficult thing to endure, and then the radiation is much more tolerable, at least the treatment sessions are. SBRT radiation can have some urinary discomfort during end of treatment and post treatment for a while. Usually clears up within a few weeks to months. Seems to be that way for me. Best wishes for you my friend.

Just curious…I’ve had three biopsies - two locally and one at the COE cancer center where I now am treated - and I was knocked out for all three. I was actually surprised to learn after the second one that some/quite a few do this under a local only.

I even asked my surgeon who did the last one (and my RP later) if I’d be out for my third biopsy, since it was at a new place, and he looked at me like I was nuts, and said, “Of course you’ll be out! I can’t have you squirming around!”

So what’s the determinant for local versus all the way under? Surgeon preference? I’ve never been offered anything but a full ticket to the twilight zone.

@turtbean Once you get past heart and other medical issues that make full sedation risky it is patient and doctor preference. Most doctors will do a biopsy (but not RP) either way. A biopsy is quick; should be no more than 20 minutes from beginning to end.

Just had perineal with general at Mayo. Lower risk of infection. Day after hardly any sign of blood and no discomfort.

@floridason I also has a transperineal and blood didn't show up for a few days but wasn't to bad. Maybe a little before starting to pee or after. What's scary is when your semen is pure red blood. That will last for a few months.

@copyman -

“What's scary is when your semen is pure red blood. That will last for a few months.”

Yes! My first biopsy, no one mentioned that, and it scared the bejeezus out of both my wife and me.

Contrast that with my third one, different doc, and both my wife and I were in the pre-op room, and he came in to give me the usual little pep talk, and he went over side effects and said, “…and you’ll have dried blood in your semen for a few months afterwards. It won’t hurt you,” and then he looked at my wife and said, “And it won’t hurt you, either!”