Biopsy anxiety

Greetings and so sorry you had to join the club. FWIW I had a transrectal biopsy with lidocaine only. It's really not as bad as it sounds IF...

1) You follow the specific instructions for prep including the horse pill antibiotic the morning of. I also got an antibiotic shot just before the procedure.

2) Allow enough time for the lidocaine to work. If the doc comes back a few minutes after the shot, tell him to go have a cup of coffee and come back. (don't ask how I know)

When all was said and done, the antibiotic shot hurt more and longer than anything else. Wishing you a very boring biopsy. 👍

Unless you really have some medically necessitated need, anesthesia is absolutely not necessary. I know many will say this that you really don’t feel anything, I did not, but you will have others that say opposite. Maybe it’s an individual pain threshold for people. Again I have had more pain from the initial shots for dental work. I had rectal. I can’t speak to perineal. Rectal was quick and easy. just follow the antibiotic regimen before and afterwards and I am immunocompromised with need for IVIG transfusions from a prior cancer twice a year. Now you will also hear how rectal is so much riskier for infection than perineal by the statistic numbers which bear that out, but a 4% to 1.4% to me are just that. You have possibly up to 2% surgical infections on almost all surgeries. My urologist had done hundreds and never seen one. He said in speaking with other urologists, it was more likely in patients that did not follow strict antibiotic protocols and the numbers also statistic numbers include patients that get them possibly in other countries that don’t have the same protocols we have. Yes, they happen, but rarely at any established US practice.

I would go to Mayo. I ended up doing Tulsa there two years ago. I also had my biopsy somewhere else and sent the results to them for a second opinion. I was Gleason 4+3 and have no evidence of disease at this point. I think they only do the trans perineal biopsy at Mayo locations. I just had one in July at Mayo Rochester and don’t remember a thing! Click on my profile to learn more about my Tulsa journey if you’re interested.

I had three rectal biopsies, and they are not really that big a deal. Yes, they are uncomfortable, but I definitely did not need to be put under for them. Had no problem driving home after.

I had one rectal biopsy and they took 15 samples. Only used lidocaine and didn't think it was any big deal, really no pain. Was surprised that there was bleeding, but only right after they finished up, no bleeding after I left facility. I should add mine was fusion guided from the MRI.

I would go where they offer Transpernial biopsy. Less chance of infection and if fusion guided much more accurate with hitting the target lesion. And of course will take core samples from other parts of the prostate as well.

You don't want a random version! Image guided or targeted only. I had two biopsies. One at my local hospital by a urologist which was a fusion trans rectal while under anesthesia. The antibiotic gave me considerable grief. Took about a month for my intestinal tract to get back to normal. The second biopsy was done at a cancer center of excellence which was a targeted transperenial also under anesthesia. Easy peasy! Walked 3 miles the following day. Anyhow, if you have a choice, transperenial is the most modern way to go. Most guys I've spoken to that have done biopsies awake tell me it's not that big of deal. Just a little uncomfortable. Both times I wasn't even asked about not being put under. I didn't even know there was an option. My guess is that Mayo would definitely do a transperenial under anesthesia.

I just had the numbing agent and really wasn't as bad as anticipated, the first clicking sound of the sample startled me but after that it went smoothly, minimal bleeding after and next day no blood in urine.

There is one additional benefit to a transperineal MRI-CT fusion prostate biopsy: the anterior lobe can be visualized although it is a nontypical site of prostate cancer. One UK professor commented that rectal biopsies are thought to be NHS substandard care.

Between 2014 and 2025, I had six biopsies because of my persistently elevated PSA and various genomic tests that pointed to an intermediate risk of prostate cancer. All but the last one were transrectal.

Two of the six biopsies were performed under anesthesia, while the other four were done without it. I had no complications from any of the biopsies, and I was able to tolerate the minor discomfort associated with the four procedures without anesthesia quite well.

Based on my experience, I wouldn’t worry too much about having a biopsy without anesthesia. The procedure itself only takes a few minutes, and in my case, the discomfort was quite manageable. Of course, everyone’s experience and tolerance for discomfort can be different, so it’s worth discussing your options with your doctor.