Biopsy anxiety

I am 68 and had a pirads 4 lesion that warranted a biopsy. The lesion was located toward on the left side, transition zone at the mid gland. This location was best aligned with a trans perineal biopsy. It was suggested a rectal approach might work, but I refused. I asked for, and received, a referral to someone who did a perineal biopsy with me being under a general. If you must have a biopsy, that’s the only way I would proceed.

After my MRI, which also identified a lesion Pi rad 4, I had a targeted biopsy overlaying the MRI to the prostate. You want to know if the lesion is cancerous. This was done in the hospital under sedation. The equipment used was only at the hospital. The biopsy also takes other samples, but focuses first on the lesion.

I’m 76 had a trans perineal biopsy last February. The procedure is not that big of deal. My biggest issue was just the look of the long needles they used🌕.

A couple of things I’m acutely aware:

I developed a uti after the biopsy they put me on Levaquin and I got the black box warning Achilles tendinitis that is only now fully healing. That was a hellish thing.
And there is a statistical finding that trans rectal biopsy has higher chance of infection due to going through rectal wall.

Good luck.

OP Here. Thanks for all the comments. I called Mayo today. They couldn’t schedule initial consultation for at least a month, then probably another month + for biopsy so I’m staying with current urologist. I feel less anxious from so many comments that it’s not that painful for most. Now just counting the days (19) until biopsy.

I had a trans rectal with novocaine in my urologist's office. I wasn't offered a choice in procedures, he does all of his trans rectal, in office. I was more than a "little uncomfortable" I was in pain during the entire procedure, and would never undergo another trans rectal unless I'm sedated. I have always had a pretty decent threshold for pain, maybe it was the Dr, maybe the lidocaine didn't have a chance to take full effect, but it was miserable, and the pain, although to a much lesser degree, lasted for several days. I have read here where many have had the same procedure with minor discomfort, that was not true in my case.

Biopsies…
I had my first rectal to prostate biopsy26 mos ago. And they did not give me anything to make it easier. In summary; it was the worst experience ever! Upon biopsy follow-up with my urologist, she was sympathetic and offered that in the future, I would be given something. This may I had to get another biopsy and my urologist was on leave so another urologist in my group of 6 at our clinic, he gave me the biopsy and was also the same to give it to me last year. When I arrived for the biopsy, the nurse asked if I had any questions, and I said yes; when do I get something for pain? She and the performing doctor said NO, we don’t give anything to patients for a rectal biopsy!!! Yes I was very pissed but had to do it regardless. This is why some men never get tested or refuse to do follow up biopsies. In summary, I would simply to insist on something to alleviate the pain…

I am "Taffy062912" who posted a long post a couple of days ago and would like to add a few things after reading others. First I am 79+. I am in excellent health. I have talked with another doctor friend of mine, not a urologist, who has had patients undergo both types of biopsies and, like those posted, some had excruciating pain from rectal approach and others who have not. It is not clear whether this is do to the skill of the surgeon doing the biopsy or the procedure itself. However, having had the perineal with additional numbing, and my brother who did the rectal, both of us this year, his was a terrible experience. Mine was not but I did insist being numbed both externally and although you have to accept one needle more to numb the prostate, internally. I cannot imagine either being done without numbing. Ask before you are there about which procedure and numbing.
It seems like the side effects and risks are much less with the perineal approach and this is the more modern approach. If the urologist does not offer it, or minimizes numbing need, go somewhere else.
As far as pain threshold, I still suggest you use your dental numbing experience and pinching your bicep as a guide to what you would feel. My dentist says I am in the top 5% getting numb. Also the ability to numb is not the same as a pain threshold. I have a high threshold for pain after a procedure, but not during the procedure. I had a double hernia operation about 15 years ago and was off pain meds and driving 3rd day with only minor pain. However, after they gave a preliminary sedative, they then give the iv for the operation in operating room and ask you to count backwards from 100. I heard the doctors and anesthesiologist check the meds repeatedly and when I was about down to 70, they said, just relax- and I was out. So numbing and sedation are not the same as a pain threshold.
One more thing on the perineal biopsy. They also insert about a Churchill sized instrument up the rectum which sonically guides the surgeon to make sure he is sampling the areas identified as suspicious by the PET scan. This seems like better approach, which I assume is not possible with a rectal approach. The instrument is well lubricated and no more painful than a rectal exam. However, they do "wax" the rectum to the scrotum to remove all hair. I was not expecting that, but at my age, I have so little hair anywhere it was no big deal. The technician did not tell me first and it was quite a surprise.

I've had two transrectal 8 years apart (ages 65 and 73), fully awake both times other than the numbing lidocaine. Just felt like some minor "pokes"....some I could not feel at all other than as a. minor "thump." Minor amounts of blood in urine after both times. Drove myself there and back both times. That's just my personal experience, however, with my personal urologist.

@taffy062912
Ouch! Ouch! Ouch!
I was told I needed a biopsy after a 3 point rise in my PSA
from 3.9 to 6.9.
I heard nightmarish stories from others who had prostatic biopsies and I was not looking forward to it.
Turns out I was put under for the procedure. Didn’t feel a thing as I was out cold.
Minor amount of blood in the urine and a pinching feeling in the perineum for a few days and that was it.
I thought that everyone had it done that way these days.

@cha625eng
No it is not. Many have transrectal biopsies and many others transperineally.

Some have no reaction or side affects to transrectal and some do including being hospitalized as had a 1-2 % increase in chance of infection. From my urologist not an opinion.

I had my biopsies done transperineally under anesthesia. For those who have stress and anxiety over prostate biopsies like I did I found transperineally with anesthesia had the less stress and anxiety as you are asleep (as at least for me). It is the way I wanted my done for the very reason of my stress and anxiety and that I did not want the additional risk of infection no matter how low it is.

It is a personal decision based on you as an individual human being not what someone else said the experience or did not experience. Talk to our urologist about the pros and cons of both and research the methods of how it is done both ways.

Chose what is best for you not what someone else recommends or their experience with it as they are not you. As I said we are all different and as individuals react differently to any type of surgeries and procedures.