Biopsy anxiety

I had 2 transrectal biopsies done. First time I was nervous but neither was a problem. It's worse going to a dentist. Both times I was awake within 10 minutes and out the door 5 minutes later. Groggy for maybe 3 hours then back to normal. The only 'moment' - was told blood is normal when you urinate after the procedure but the amount of blood the first time is staggering. Was ready for this the second time. Gradually resolved over 3 or so days both times. Being at the hospital 4-6 hours was the worst part.

I believe that the doctor taking the biopsies is the one who makes it a big deal or not! I had a radical prostatectomy in 2008 and the usual anal biopsy before surgery! It was one of the most excruciating experiences I've ever had in my life. Twelve biopsies and when the doctor finished I had to sit on the table at least 10 minutes before I 4could finish dressing. I don't mean to frighten you but make sure you know ahead of time what your biopsies will entail.

I was very anxious because from dental work, I know that I am hard to numb. First you should have had an MRI to identify regions of interest. There are 12 areas to potentially sample. From my MRI, they did 9. Second, the region between the anus and scrotum is now the preferred place. My brother had biopsy through rectum and it was very painful. I insisted that the urologist do extra numbing at both the outside and inside, which is not normal. Where I went, they watch you take the 5 mg of valium at the location, but you have to get the prescriptions and bring it there. I also insisted in getting 2 generic Percocet pills and taking them at same time. It takes about 30-40 minutes for Percocet and valium to take effect. The numbing with needles just takes a few minutes. The first needle to numb prostate is a little intense. After all was numb, all the samples were not much more than slight pinches. Pinch yourself on bicep and that is all you feel for each sample. However with all the sedatives and Percocet you will need a driver home. This facility also required someone wait the entire time. Total recovery after is about 6 hours before drugs wear off. I did take a generic Vicodin when I got home after the 6 hours, but probably not needed. You probably will have some blood in urine for a couple of days. I did not have any in bowel movement since the samples were not taken from rectum. Also did not need any anti-biotics for the same reason. You will have difficulty urinating on day 2-4, but not serious. You also will have some blood in semen for a few days. The problem with a full anesthesia is, at my facility, they do not do that on an out-patient basis and I have a small dog I have to take care of so I could not be gone overnight. But local inpatient worked out ok and still took dog to dog park in afternoon and drove ok, cooked supper ok.
You will have a procedure similar biopsy if you do SBRT external radiation where they insert gold beads in prostate and a rectal spacer , also through the perineum. This second surgeon did not listen to my concerns about additional numbing and it was very painful, even with the Percocet. Thankfully it was only a total of 4 inserts for beads and spacer. If you do internal radiation, they place radioactive particles in prostate, so a similar procedure as prostate biopsy. So numbing is important if you find you are hard to numb from dental procedures. I would ask the surgeon specifically before doing the samples, and after the initial numbing of outside, if he did the additional numbing to confirm he did, and not assume he will remember or follow your directions. It is just a few extra minutes to numb prostate. If I had not been strapped down and and on valium I would have shown the second surgeon what it felt like after he poked me and said "I'm 'saw we' " -four times in his foreign accent. I did the second procedure and all the radiation at The Ohio State University in Columbus Ohio. The radiation is painless and only takes a few minutes each time and no numbing is required. Does not require anyone wait or drive you, but you do feel tired after a few hours and probably not safe to drive if you live further away.

@wheel1
Would mention, I was in and out from 30 minutes and drove home.

There's some great advice here, the only thing I can add is that I got Antibiotic Induced Colitis after each of my biopsies. If you are prone to Colitis with Antibiotics Get your PCP to give you something for Nausea and something to help your stomach not cramp so much. I got Zofran and Bentyl to help.

I've had two trans rectal biopsies. I also was very anxious. The reality was not a big deal. The key was application of topical Lidocaine to begin, allowing it some time to work, followed by injected Lidocaine which you won't feel if the topical Lidocaine was applied sufficiently. I am not good about medical procedures but, at least for me, it was uncomfortable because of the position you're in but the pain was minor. I even wrote a note to one of the doctors about how it was much easier than I expected.

@malligood
I have learned over my 79 years of life and having very serious health condition what one experiences with testing like biopsies and how they are done are dependent on the individual.

What another experiences without being anesthesia is specific to their body, their urologist, equipment, experience and you the individual patient with you specific pain threshold.

My wife has a very low pain thresholds mine is much higher thus we are all different. I had transperineally biopsies at Mayo Jacksonville with anesthesia. What did I feel nothing. No discomfort prior, during (asleep) and nothing when I woke up. What I can pass on to you is my personal experience. Another person is not going to be able to tell you what you personally are going to feel.

Mayo Jacksonville is excellent care. They can do both transrectal and transperineally based on you and your urologist. Do what is best for you both mentally and physically not what others did or not did, or what they felt or not felt including me.
Good luck.

I had both a transrectal and a trans perineal biopsy. Neither without anesthesia. For me they were no big deal, minor discomfort during both. I was a bit more anxious about the trans perineal because of the positioning, but both were over with quickly enough and I didn't have any problems afterwards (well, blood in semen is a big mess, be prepared for that). If both are an option and the patient is okay with either, then medically trans perineal is a little better but transrectal is a perfectly good option.

@jc76 who is your urologist at Mayo Jacksonville? I’m going to call and make an appointment. Other than biopsy concerns, I don’t have a good feeling about my Atlanta doctor

@malligood
Dr. Gundian. But all their urologist are excellent.

Early this year they open up their new cancer center which now offers proton radiation therapy while in past only could offer photon.