1. < Prostate Cancer

How did your TRUS biopsy go?

Posted by tgregg99 @tgregg99, Mar 30 11:09am

Hi,

I'm 73 with BPH (1 year+, taking combined therapy of Finasteride + Tamsulosin to control my symptoms). My prostate MRI last year confirmed my BPH, but showed no concerning cancer lesions, although my urologist claims an MRI may not detect 10-20% cancer. The MRI also showed an inguinal hernia but I've had no symptoms yet.

My annual total PSA levels have increased a bit over the last few years (4-8+ range), although my doctor claims my high free PSA levels (good) indicate BPH and not cancer. Still, my urologist recommends that I proceed with a TRUS prostate biopsy.

I'm aware of the controversial nature with PSA tests in general, so I'm ambivalent about having the biopsy. And I'd be a liar if I said I'm not anxious about having the biopsy. But I'm told it's the only way to confirm if I have cancer. So ...

I would appreciate your thoughts if you've had a TRUS prostate biopsy, including: if you had sedation or local anesthesia only, did it go smoothly, did you experience any pain, do you feel the results were accurate, were you admitted for observation after the procedure, and do you believe strongly that I should seek a second opinion? I live alone so I'm concerned about possible risks and would feel better having observation overnight if needed.

Thanks in advance for your thoughts!

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tgregg99 | @tgregg99 | 5 days ago
In reply to @garylr "I've had two MRI-guided TRUS biopsies - age 66 for the first, 67 for the second...." + (show)
@garylr

I've had two MRI-guided TRUS biopsies - age 66 for the first, 67 for the second. Both times, the urologist indicated that I would be under "twilight sedation," which I understood to mean "conscious, but out-of-it." I was given Propofol, and I was unconscious through both procedures. Woke up feeling fine and walked out of the hospital under my own power. I was on my way home a little over an hour after they took me to the OR. They required me to have a driver (my wife), but I could have driven myself, no problem.

A little blood in my stool the first time I had a BM. Blood in my urine for a few days, but after the first time I peed, it was just a little pink for a couple of seconds and then went clear. Blood in my semen until I had ejaculated maybe 6 or 8 times. They had told me to expect blood in my semen, but I was thinking a little pink, like my urine - but the first couple of times, it was the "murder semen" @scottbeammeup mentions. A little unnerving!

No pain for me. Just a little "pressure" - felt like I needed to have a bowel movement when I didn't. That lasted two or three days.

No antibiotics before or after, but they may have given me some intravenously during the procedure.

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Thank you for your helpful feedback!

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tgregg99 | @tgregg99 | 5 days ago
In reply to @clandeboye1 "@tgregg99 I agree with @heavyphil . Go for a TRANSPERINEAL MRI Fusion Biopsy . TRUS is..." + (show)
@clandeboye1

@tgregg99 I agree with @heavyphil . Go for a TRANSPERINEAL MRI Fusion Biopsy . TRUS is OLD SCHOOL I'm 85 and both my Transperineal Biopsies were a walk in the park . NO ANAESTHESIA . I sat for 10 to 15 minutes in the side room after - and drove home . Miminal blood in my stool and urine for less than a week - both times , A 16 Core Biopsy .
NOTE : The TRUS ( TRANSRECTAL ) Biopsy is illegal in Norway following the death of a patient from Sepsis . The family formed an opposition group and won their court case to ban this type of Biopsy . The ban is being considered in other EU countries plus numerous Urologists worldwide , are refusing to perform the Transrectal in favour of the new TRANSPERINEAL method .
Following behind , is the newer " REAL TIME BIOPSY " CALLED : AN IN -BORE OR GANTRY BIOPSY ", where you are inside the bore of the machine ( MRI ) when the biopsy is being performed .
Machine cost is slowing the broader coverage of this new technology as is the use of the more advanced MRI Tesla T 7 machines which will replace the Tesla 3 T machines , which had replaced the 1.5 machine .

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Very helpful info, thank you!

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1 reply
tgregg99 | @tgregg99 | 5 days ago
In reply to @surftohealth88 "My husband had total of 2 biopsies in span of 6 years - both were transperineal..." + (show)
@surftohealth88

My husband had total of 2 biopsies in span of 6 years - both were transperineal robotic assisted and also MRI and ultrasound guided. He had sedation, not general anesthesia (last time anesthesiologist insisted that he get general a. but we absolutely refused - WTH ???). I am sure that made bigger profit margin for surgical-center since there is NO reason for that. God help us with this medical system ... He also got one dose of antibiotic during procedure. He spent time in recovery room until he was able to urinate without problems (that was " test" that he needed to pass to get release form ). He had no blood in urine nor in feces and the only thing was some soreness in perineal area for 2 days.

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Thank you so much!

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tgregg99 | @tgregg99 | 5 days ago
In reply to @breadmaker "I have had three transrectal biopsies - this was before I was aware of transperineal. They..." + (show)
@breadmaker

I have had three transrectal biopsies - this was before I was aware of transperineal.

They were uncomfortable but not too painful. I had local anesthesia, though on the 3rd biopsy with a new urologist/surgeon he suggested nitrous oxide, which helped calm me down. I had to pay $125 out of pocket for that. (I had told him that I was "jumpy" on the first two.). At the time I felt it was worth it, but now I'm a bit on the fence if I'd bother next time.

I was fine afterwards for all three and drove myself home on the first two. I could have driven myself on the 3rd but my wife wanted to be there, so she drove.

I don't think they'll keep you overnight and I don't think there's a need to do so.

Transperineal does appear to be the preferred method, though some have said that it was more painful for them. So, it might just be a factor on your pain threshold. Mine isn't very high.

That said, your MRI results seem to indicate that you can wait on a biopsy - but I'm no expert on this. There are so many other factors to consider with PCa. If there's another factor that has you concerned - like family history - then I would proceed with the biopsy.

And I personally would go with transperineal.

All the best to you.

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Thank you for your feedback, very helpful to me!

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clandeboye1 | @clandeboye1 | 4 days ago
In reply to @tgregg99 "Very helpful info, thank you!" + (show)
@tgregg99

Very helpful info, thank you!

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tgregg99 An update .
Norway is not the only country currently banning TRANSRECTAL BIOPSIES .
Australia and the UK are transitioning to the TRANSPERINEAL BIOPSY due to infection concerns and improved results . A senior Urologist in Australias' Goldcoast , has yet to record
" one incidence of infection in 15 years ' performing the new procedure ".
He qualified his statement by saying , " They chances of infection are very , very low . ' However you can never say they are ZERO ."

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hoops0200 | @hoops0200 | 3 days ago

I had my TRUS biopsy on March 5—so 29 days ago. I’m 54 years old. It was a transrectal biopsy with ultrasound guidance, done under local anesthesia, so I was fully awake. I was given an antibiotic about 5 minutes before the procedure.

I was told to fast after midnight, but that turned out to be unnecessary. A nurse called mid-morning and asked if I could come in an hour earlier. I mentioned I was really hungry and thirsty, and she said the NPO order was a mistake. She recommended I go ahead and have a few crackers and some water since the procedure was soon. Looking back, I wish I had eaten a little more.

The procedure itself went smoothly. I felt fine afterward and left after about 25-30 minutes. However, on the drive home, I passed out in the car. Thankfully, my wife was driving. I had just told her I felt nauseous, and within 2–3 seconds, I was out cold. She was understandably terrified. We went to the ER, and thankfully all I needed was fluids and a snack. All the tests came back normal. It was likely just a combination of nerves, fasting, and my body not loving the experience.

It was the first time I’ve ever passed out, which made it a little scary—but everything turned out okay.

As others have mentioned, the first couple of ejaculations post-biopsy included a lot of blood—what some here have called “murder semen,” which is a fitting (and disturbing) description. Even though I was warned, it was still jarring. That gradually got better. I’ve been following the advice to ejaculate every 2–3 days to help clear things out. The last 7–8 times have been lighter in color. Last night was just a light rust color.

My wife has been incredibly supportive with all of that. We’ve been together almost 30 years and have always had a "strong relationship," so to speak, so her encouragement has meant a lot.

Also, no blood in my urine as of Tuesday morning, and it’s stayed clear for the last three days. It was never a lot—just a drop or two at the beginning of urination—but I’m hopeful that part is over.

To be honest, though it wasn't a horrible experience overall in most respects, I truly hope I never have to have another one, even with one of the other methods. I'm pretty young, so I am hopeful that the Finasteride and other measures will get me right.

Oh, and most importantly: biopsy results came back all clear. Very thankful for that, though there are follow ups coming up at the 6-month point. Best of luck with yours if you get one!

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