Transperineal biopsy under local; positioning, experience

It's not bad at all. You are flat on your back and your legs are strapped into stirrups (think gynecological exam), raised, and separated. There was a big man (Willy) that did all of the prep including securing the scrotom and penis out of the way and a warm blanket placed so that exposure was minimal. There was one nurse monitoring vitals but she remained up by my head. Very little to be embarrassed about despite the nature of the procedure.

It seems that the probe concerns you as well. While it can be somewhat uncomfortable, especially when the surgeon moves it around, it is not painful at all.

The surgeon will probably give you a 1,2,3 warning before each sample is taken so you won't be surprised when the spring loaded needle is fired into your prostate. They are not painful.

Pain is not really a concern. They topically numb the perineum with lidocaine, then give a couple of shots of lidocaine into the perineal area (kind of like a very mild bee sting), followed by a couple more shots of lidocaine into the prostate itself which acts as a nerve block. These are marginally briefly worse that the other shots, but are still really just a sting or pinch.

The process is over quickly. I was just as apprehensive as you and was surprised at how easy it was. Don't worry about it! Compared to what may lay ahead this is a piece of cake.

I had two that were done at private urologist office. The first one gave you an inside on what to expect when having the second one. It was uncomfortable , but it was over quickly.

The third one done at Mayo was another story. Not sure on why it took so long, there may have been a resident who was involved. I was expecting 12 biopsy specimens, but was informed it was going to be 18. It was not a quick process and the most upsetting to me was that I was not informed if they were having technical issues or what. After it was completed, my blood pressure was very low and required additional monitoring.

Based on that last experience, I tell everyone to request sedation with anesthesia.

I am in the same situation, The PA told me I needed to get a TP biopsy. She told me it would be done under local. I asked if they give other meds like Valium to relax you. She said no - they did offer it for a brief period but some patients had some issues so they stopped. I asked about sedation and she said 90% of patients have local. I got the feeling she was pushing local for their convenience and quicker scheduling. I told them I want sedation. They must know patients have high anxiety. They should offer conscious sedation; that can be done in the office. I also think the sampling will be more accurate since I won't move under sedation. Also less for the doc to worry about. Anyway waiting for their scheduler to book OR time, good luck.

@davidhi31
Sedation can be done in the office but you still need then a nurse skilled in setting up the IV administration of it and the doctor calling the shots regarding starting and stopping administration. I think many would rather ignore all the additional work due to convenience and just do the local.

@wheel1 conscious sedation can be done in the office. Twilight or deeper sedation requires an anesthesiologist and is done in an OR or surgi-center,

@davidhi31
I was referring to conscience sedation i.e. versed is still administered by IV set up within an office.

@wheel1 You're right, conscious sedation seems like it would be better than a local. From what I've read, it's not widely offered with a TP biopsy. There's a good podcast from University of Michigan about TP biopsies, sounds like they're prioritizing patient anxiety, experience, etc. (Google if you're interested in it, the site won't let me share a URL.)