Transperineal biopsy under local; positioning, experience

Mine was over with quickly, just talked to the nurse and NP the whole time, it eased my nervousness. No embarrassment, they do these all day one after the other. No pain really, just discomfort. Only advice, after the procedure and you stand up, do not look back at the operating station, there will be blood. I am not squeamish around blood, so just found it both gross and interesting. Also, they had a movie playing, so kept my eye on that. It was not a big deal for me at all. Best of luck!

@surftohealth88 Exactly right! It is advantageous for the med team and facility to get you in and out asap. Insurance is happy too. They don’t have to pay for the sedation. OP has taken the time and trouble to start this thread. To me that is enough reason to insist on the sedation.

The scene was unusual. I was on my back, legs spread apart, with everything hanging out. The male urologist performing the procedure had two female assistants. So forget about being embarrassed.

The MRI images could not be conveyed to the doc's computer due to he was a community urologist and the MRI was conducted at a big city NCI designated cancer center. Their systems were incompatible. I had access to the images through my MyChart page. So the doc studied the images on my laptop for a few minutes, formed a picture in his mind of where he wanted to make sure he got good samples from, and proceeded to do a "cognitive" biopsy.

It seemed very ad hoc to me. I accepted the chaos because I wanted any sort of more immediate data I could get my hands on, as the MRI report was "clinically significant cancer highly likely".

Afterward, I wondered why I had been so worried about going through this. The doc and his assistants were highly skilled. Just as my apprehension reached a peak one nurse moved in and held my hand while she mumbled some soothing words, which sort of surprised me, as this helped a lot. So much for any image of myself as a tough brave sort of guy who can stoically endure whatever comes up.

The worst part of the whole thing for me was the "click!" sound that I heard as the doc activated his probe to take yet another sample of tissue. My vivid imagination would kick into gear even though there was hardly any pain.... Ack! I'm being hacked to pieces, starting in the worst place imaginable!!

I had three biopsies before being officially diagnosed and I was out for all three. I wasn’t even aware doctors did these with a local.

I found that out between the second and third ones. As I was going to a new doc at a COE, I specifically asked if I’d be sedated. His response was kind of funny, along the lines of, “What?! Of course you’ll be sedated! I don’t want you squirming on me!”

I've had three trans-rectal biopsies and my first perineal a couple weeks ago. All were done wide awake with local anesthesia. The perineal was definitely the easiest and quickest. I was given the option of general anesthesia (since it was a different facility than the rectal), which I couldn't do because of scheduling. Turns out, it wasn't necessary. Others have described the position you're in with your feet strapped into the stirrups (I asked the nurse if that was to keep me from running away and she looked at me dead serious and said "yes, that's exactly what it's for"!). The worst part was getting the local directly into the prostate - one on each side. But that was just a few seconds; after that, I didn't feel anything. There was blood in my urine right after which disappeared by that afternoon. Blood in the semen takes much longer, perhaps a month. You will want to "take matters in your own hands" until it stops so as not to freak out your partner.

@phbphd1992
I want to mention we all hear about the blood in the semen, but for most it is not what we initially think oh my god, blood like watching a cut bleed. What it does is turn your thick semen rust color from the blood. It is still a shock.

Regarding blood in the semen, the first time it happened after the first biopsy, I’d had no real warning, and to say it’ll alarm your partner is an understatement.

Second biopsy, I was told (and I don’t mean by the doctor!) to wear a condom or make solo plans.

Third time, both MrsTurt and I were meeting with the surgeon just before the procedure, and he was going through the post-op stuff, and at one point, he said, “…and you’ll have blood in your semen for several weeks. Don’t worry, it won’t hurt you.”

Then he looked straight at my wife and said, “And it won’t hurt you, either!” 😆

Other responses have covered the experience very accurately. I've had 2 perineal biopsies over recent years and both were routine and as described by @keith156 above. The nurses who "arrange" your junk and assist have done hundreds (thousands) so nothing surprises them. For both of mine, I had a conversation with my urologist during and after. Some on this forum have opted for anesthesia and most docs will offer that but prefer not to do a general anesthesia. It's a short procedure--10-20 minutes. Good luck.

I had one a week ago without sedation. To start with I bent both knees towards chest lying on my side and stayed there till he was finished. Once he started the procedure it took about 15 minutes it was somewhat uncomfortable but not intolerable pain, the first click of the needle taking samples startled me but after that the other 11 didn't bother me. Had minimal bleeding that lasted the day of, the following day it cleared up. Took it easy for three days than on day four went back to the gym and did my normal routine waiting for results.

I had a transperineal with local anesthesia. My urologist said it would be like getting cavity filled by a dentist. There were some similarities. The sensation of the needle giving you the local anesthetic. The click with moderate pain when each sample is taken could be compared to having a tooth drilled. When I looked at the length of the needle used the nurse said, "Don't look at this!" I said, " I can't unsee it". I was told that there could be blood in my urine afterwards. I wasn't prepared for what looked like mostly blood coming out when I first relieved myself. It got fainter with each urination. There was just a slight tinge after 9 days. One good thing about the local anesthesia was that I was able to drive myself home, a 45 minute drive without any problem.